Survival rate of pediatric acute lymphoblastic leukemia patients with hyperleukocytosis at Udon Thani Hospital

Abstract

Background: Leukemia represents the most prevalent form of cancer in the pediatric population. The majority of affected children achieve favorable outcomes with standard treatment regimens, with high cure rates. However, the presence of hyperleukocytosis at initial presentation has been associated with increased risks of early complications and mortality. Data from studies conducted in developed countries indicated that the cure rate for pediatric patients with acute lymphoblastic leukemia (ALL) and hyperleukocytosis was approximately 64.5%. In contrast, a study conducted by the Faculty of Medicine at Prince of Songkla University reported a significantly lower overall survival rate among pediatric ALL patients with hyperleukocytosis compared to those without this condition, at 37.2% versus 67.8%, respectively (p value < 0.0001). These findings highlight a disparity in outcomes between patients in Thailand and those in more developed healthcare settings. Notably, this is the first collected report at Udon Thani Hospital, thereby providing the rationale for the present study.

Objective: To determine the survival rate of pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) presenting with hyperleukocytosis at Udon Thani Hospital.

Methods: This study employed a retrospective design. Data were collected from medical records of pediatric patients diagnosed with acute lymphoblastic leukemia accompanied by hyperleukocytosis who received chemotherapy at Udon Thani Hospital between July 2010 and November 2019. Patient information was retrieved from the hospital’s electronic medical record database, including demographic, clinical, and laboratory findings.

Results: This study included a total of 22 pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) presenting with hyperleukocytosis at Udon Thani Hospital. The mean age at diagnosis was 6.3 years old (range: 0.3–14 years), with a male predominance (59%). The majority of cases were classified as B-ALL (64%). The most common clinical manifestation was hepatosplenomegaly, observed in 95.5% of patients, followed by fever (81.8%) and abnormal bleeding (54.5%). At diagnosis, the mean white blood cell count was 210,000 cells/cu.mm. (±247,683.7), mean hemoglobin level was 6.6 g/dL (±2.7), mean platelet count was 29,318 /cu.mm. (±17,038.8), and mean lactate dehydrogenase (LDH) level was 5,869 U/dL (±4,579.2).

The most frequently observed early treatment-related complication was tumor lysis syndrome, occurring in 31.8% of patients. The five-year overall survival rate was 68.2%. No statistically significant associations were identified between overall survival and factors such as age at diagnosis, sex, white blood cell count, or leukemia subtype.

Conclusion: The findings indicated that pediatric patients with acute lymphoblastic leukemia and hyperleukocytosis treated at Udon Thani Hospital had a five-year survival rate of 68.2. No statistically significant prognostic factors were found to be associated with survival outcomes.