Retrospective Study of Pediatric Acute Leukemia

Purpose: To evaluate the therapeutic result and analyze the prognostic variables of pediatric acute leukemia treated with chemotherapy and prophylactic cranial irradiation (PCI) at KMCH over the past 10 years. Materials and Methods: From September 1987 to March 1996, twenty-two patients with acute leukemia received PCI at Kaohsiung Medical College Hospital. There were 9 boys and 13 girls between 1.6 and 17.4 years of age at diagnosis. According to French- American-British (FAB) classification, seventeen patients had acute lymphoblastic leukemia (ALL) and 5 patients had acute non-lymphoblastic leukemia (ANLL). The radiation dose was 1800 cGy given in 10 to 15 fractions. Prognostic factors such as leukemia subtype, age, sex, hemogram, hepatosplenomegaly, lymphoadenopathy and radiotherapy fraction were analyzed by retrospective review of the medical records. All patients were followed up regularly. The median follow-up time for patients still alive were 4.8 years (range 2.7 to 7.16 years). Results: The common acute reactions were vomiting and headache. The 5-year disease-free survival rate was 50%. Overall median survival time was 6 years; ALL was 6.16 years and ANLL was 2 years. Only one patient (5%) suffered from CNS relapse 1 year after PCI. The major cause of death was sepsis (55%). Adenopathy was the significant prognostic factors in this study. Conclusion: Leukemia involvement of the CNS remains a major clinical problem despite the improved disease control provided by mordern treatment regimens. In this study, excellent CNS prophylactic result (95%) was achieved in our cases, and we recommend that PCI should be incorporated in the management of pediatric acute leukemia. Besides, the most significant prognostic factor was adenopathy.