Background: Acute Lymphoblastic Leukemia (ALL) survival in the Philippines remains poor due to poor access to treatment. Financial constraints, particularly out of pocket expenses for chemotherapy drugs are a main barrier. In 2012, a program for free ALL chemotherapy was implemented in the three (3) pediatric cancer units and thirteen (15) hospitals nationwide. We review the program's impact on ALL outcomes.
Methods: Multi-center, retrospective study of newly diagnosed ALL patients from January 1, 2012 to December 31, 2015. Study end-point was December 23, 2017.
Results: All 1340 patients' charts enrolled in the program were reviewed and analyzed. Diagnosis was based on immunophenotyping in 697 (52%) and morphology in 643 (48%). Mean age at diagnosis was 7 years old (0.8-18). M:F Ratio 1.5:1. NCI risk stratification: low 53%(n=709) and high 47% (n=631). Treatment protocols (n=7) varied across centers. At end of study period, that without outcome of death is 76% (n=1015), 43% alive (n=570) 24% died (n=325), 12% relapsed (n=163), 30% abandoned treatment (n=400). Most common cause of death were sepsis and bleeding. There were 163 relapses (12%) Relapse sites were bone marrow 63% (n=103), CNS 32% (n=52) and combined 5% (n=8). The 5-overall survival (OS) and abandonment-sensitive OS was 64% (95%CI 61% to 68%) and 27% (95% CI 22% to 31%). Multivariate analysis of patient characteristics showed mortality was strongly correlated with initial age at diagnosis >10 years old and <1 year old, hemoglobin <7g/dL and platelet counts ≤100X109/L.
Conclusion and Recommendation:
ALL outcomes show treatment abandonment and toxic death are significant problems; and further studies are needed to understand the reasons for and the prognosis of patients with treatment abandonement. A comprehensive national leukemia program is needed and should include initiatives on infection control, standard clinical practice guidelines and creation of hospital registries.