Prognostic factors and outcomes of pediatric acute lymphoblastic leukemia using ThaiPOG protocols: a single institute experience

Background Acute lymphoblastic leukemia (ALL) is the most common malignancy among children. Disease-based risk stratification was incoporated in the Thai Pediatric Oncology Group (ThaiPOG) protocols to adjust intensive chemotherapies,and central nervous system-directed treatment. Although treatment outcomes have improved over the decade, excellent outcomes are counterbalanced by treatment-related toxicities, especially in countries with limited resources like Thailand. Objective The single institute study aimed to evaluate prognostic factors associated with survival outcomes in pediatric ALL using ThaiPOG protocols at Phramongkutklao Hospital. Materials and methods Pediatric patients with ALL treated at Phramongkutklao Hospital between 2014 and 2019 were retrospectively reviewed. Results In total, 50 patients with a median age of 9.64 (range, 0.34-19.81) years were studied. The most common immunophenotype was pre-B cell ALL (N = 42, 84%). The 5-year overall survival (OS) and event-free survival (EFS) were 80% and 76%, respectively. The major mortality cause was treatment-related infection (N = 7, 14%). Unfavorable cytogenetics was the only factor associated with OS (p = 0.006) and EFS (p < 0.001). Conclusion The outcomes of pediatric ALL in Thailand were comparable to those of developed countries. Cytogenetic testing is essential for stratifying disease status and tailoring treatment protocol accordingly. Infections remain the leading cause of death among pediatric patients with ALL.