Analysis Of Treatment Failure In Children With Acute Lymphoblastic Leukemia

Objective: To summarize the causes of treatment failure and to assess the cost of the two regimen of chemotherapy for ALL.Methods: Medical charts of 231 patients who received a diagnosis of acute lymphoblastic leukemia between 1998 and 2003 were abstracted retrospectively at Fudan University Affillicting Children's Hospital, Shanghai. Data on treatment results and total hospitalization charge of all children were collected. A cost minimization analysis was performed to assess the cost of the two regimen of chemotherapy. The patients who received therapy for less than 1 month after diagnosis were accounted as early protocol compliance failure, those who had completed the induction therapy but received therapy for less than 6 months after diagnosis were regarded as interim failure in protocol compliance, and those who gave up therapy or were lost in follow-up after 6 months with stable disease or complete remission were accounted as late compliance failure.Results: Totally 231 patients were diagnosed to have ALL. Of all the patients, 147(63.6%) experienced treatment failure. All the patients were divided into two groups: the first period (1998.1-2003.5) and the second period (2003.6-2006.12). 90 patients (75.6%) were diagnosed in the first period and 57 patients (50.9%) in the second period and there was significant difference between the two groups(p<0.001). The total protocol compliance failure was 48.1%. Of those patients, 73 cases (31.6%) belonged to early protocol compliance failure, 24 (10.4%) and 14 (31.6%) were respectively classied into interim and late compliance failure. The rate of protocol compliance failure was higher in the first period than in the second period (57.1% vs 38.4%, p=0.004). The independent risk factor for compliance failure included: age (0.05). The mean hospitalization cost for non-high risk patients was 176947.2±74844.0 yuan per patient in the first group and 92065.48±29782.35 yuan per patient in the second group, indicating significant difference between them. Conclusion: The most common cause of treatment failure in childhood ALL was protocol compliance failure. This problem need special concern. Outcome could substantially improved by interventions that to prevent abandonment of therapy and to reduce treatment-related death.