Clinical and treatment outcomes, prognostic factors, and survival in pediatric acute leukemia

Purpose: The aim of this study was to evaluate overall survival and treatment-related mortality in children with acute leukemia treated in a middle-income healthcare setting and to test the hypothesis that early treatment response and sex independently predict survival outcomes. Materials and Methods: We retrospectively analyzed 105 pediatric patients diagnosed with acute leukemia between February 2021 and May 2023 at the Health Sciences University, Adana City Training and Research Hospital, Turkey. Data were obtained from institutional electronic medical records. Overall and event-free survival were estimated using the Kaplan–Meier method and compared using the log-rank test. Results: The median age was 9 years. Acute lymphoblastic leukemia was diagnosed in 91 patients, acute myeloid leukemia in 13, and mixed-phenotype acute leukemia in one. The overall survival rate was 62.6%. Survival was higher in girls than in boys (80% vs. 48%). Patients with a favorable day-8 steroid response demonstrated substantially higher survival than poor responders (83% vs. 35%). In multivariate analysis, early steroid response was independently associated with a marked reduction in mortality risk. Conclusion: In this single-center cohort from a middle-income country, female sex and early steroid response were associated with improved survival in pediatric acute leukemia. However, treatment-related mortality remained substantial, underscoring the need to strengthen supportive care, infection control, and access to modern risk-stratified monitoring. Incorporation of early response assessment and molecular follow-up into routine clinical practice may further improve outcomes, although the lack of minimal residual disease data limited more refined prognostic stratification.