Survival and outcome of acute lymphoblastic leukemia in Children Attending Leukemia Center in Al- Kuwait University Hospital in Sana’a, Yemen

Background: Acute leukemia is the most common cancer seen in children in Yemen. Leukemia represents the 11th and 10th most frequent cause of cancer morbidity and mortality worldwide, respectively. The survival of patients with acute lymphoblastic leukemia (ALL) has improved significantly with the use of intensive multimodality treatment regimens. There are advances have been made in the treatment of acute lymphoblastic leukemia with 5-year overall survival rate reaching 90% in the high-income countries. Objective: To determine the five years survival and outcome of children with acute lymphoblastic leukemia (ALL) admitted to leukemia center in AlKuwait university Hospital in Sana’a, during the period from January 2011 to January 2015. Methods and patients: A cross-sectional retrospective study which relied on reviewing data available in patients’ records in leukemia center. A checklist was prepared for data collection which included demographic data, WBC counts, remission of ALL, relapse cases, 5 years survival, outcome and causes of death. SPSS software was used for data analysis. Results: This study included 171 children of ALL. Males represented the majority in a rate of 69.1 %. Most cases (about 46.2%) were in the age group from 1 to 5 years, and 31 % were in age group between 6 to 10 years. Most cases (85%) of children are with total WBC less than 50000. Most of children (about 83.6 %) develop complete bone marrow remission at day of 22 of start chemotherapy. There is 72.2 % of known cases survive more than 5 years from date of diagnosis while 57.7 % of known cases survive more than 5 years after finish chemotherapy. Children with relapse of acute lymphoblastic leukemia were 27 %. The rate of cure of acute lymphoblastic leukemia in pediatric patients was 45 % and the patients discharged against medical advice (DAMA) were 8.8 % while 24 % of cases were died, and there were 2.3 % relapsed cases. On other hand there were 19.9 % of cases lost during follow-up. The most cases of death died during chemotherapy 73%, then 15% died before starting chemotherapy, and 12% died after complete chemotherapy period. The infection wasmost common cause of death 51.2 %. Conclusions: About half of cases of acute lymphoblastic leukemia were in the age group from 1 to 5 years. Most of children with acute lymphoblastic leukemia develop complete bone marrow remission at day of 22 (about 83.6 %). There is two third of known cases of acute lymphoblastic leukemia survive more than 5 years from date of diagnosis and about one fourth of all cases relapsed. About half cases of acute lymphoblastic leukemia in pediatric patients were cured, while less than fourth of all cases died and more than half of dead cases died due to infection. The outcomes of acute lymphoblastic leukemia continue to improve with more long-term survivors, decrease complications and treatment side effects should become a major focus. Future research could focus on identifying factors affecting the outcome and causes of death among children with leukemia.