Comparison of Outcome of Induction Chemotherapy In Pediatric Acute Lymphoblastic Leukemia Between Standard Risk  and High Risk Group

Objective: To compare the outcome of induction chemotherapy in paediatric acute lymphoblastic leukaemia between standard risk and high-risk groups. Study Design: Prospective Comparative study Place and Duration of Study: Paediatric Oncology Department, Combined Military Hospital, Rawalpindi Pakistan from Sep 2018 to Aug 2020. Methodology: All cases of paediatric Acute lymphoblastic leukemia, who completed induction chemotherapy were included in the study. They were divided into two groups on the basis of National cancer institute criteria. Standard risk group received dexamethasone, vincristine and peg-asparaginase while high-risk group received dexamethasone, vincristine, peg-asparaginase and daunorubicin. Bone marrow examination was carried out at day 8 and 15 and then at the end of induction to document remission status. Results: A total of 233 patients of Acute lymphoblastic leukemia were included in the analysis. One hundred and twenty (51.51%) patients were in standard risk group and 113(48.49%) were in high-risk group. Remission after initial marrow was significantly higher in standard risk group as compared to high-risk group 101(90.17%) vs 58(55.77%), p=<0.001). However remission after day 29 marrow was higher, but not statistically significant, in the standard risk group than the high-risk group 93(97.89%) vs 77(92.77%) group (p = 0.185). Conclusion: Patients in standard risk group have high remission after induction chemotherapy as compared to high-risk group. Patients in high risk group have more complications and higher treatment related mortality as compared to standard risk group.