Abstract Background: There is limited data available on the treatment outcomes of pediatric rhabdomyosarcoma (RMS) in Asian populations. Therefore, we aimed to review the baseline characteristics, clinical outcomes, and prognostic factors in children with RMS from Thailand. Methods: The data of children under 15 years of age diagnosed with RMS between 2003 and 2019 from a large tertiary hospital in Southern Thailand were retrospectively reviewed. Descriptive statistics were utilized to describe the clinical characteristics. The Kaplan–Meier method was utilized to estimate survival. Cox proportional hazards regression analysis was utilized to determine prognostic factors that affect survival. Results: A total of 42 children RMS were included in this study. The median age at diagnosis was 6.4 years (IQR, 2.4–10.2). Among these patients, 11 (26%) were older than 10 years, and 13 (31%) presented with metastatic disease at diagnosis. The 5-year overall survival (OS) rate was 39% for all children. Age greater than 10 years (hazard ratio (HR): 3.3, 95% CI: 1.2–9.2) and metastatic disease at diagnosis (hazard ratio (HR): 2.8, 95% CI: 1.1–7.5) were independently associated with poorer survival. The 3-year OS for children with metastatic disease (stage IV) was 15% (95% CI: 4.3–55). Conclusion: The percentage of metastatic disease in our cohort was higher than that in previous reports and may have contributed to a poorer outcome. Age greater than 10 years and metastatic disease at diagnosis were noted as adverse prognostic factors.
Abstract Background: Childhood leukemia with musculoskeletal (MSK) involvement mimics various conditions, which consequently leads to diagnostic delays. The clinical implication of MSK involvement in this disease on survival outcomes is inconclusive. This study aimed to compare characteristics and survival outcomes between MSK and non-MSK involvement in childhood leukemia. Methods: The medical records of children newly diagnosed with acute leukemia aged under 15 years were retrospectively reviewed. Two-to-one nearest-neighbor propensity score-matching was performed to obtain matched groups with and without MSK involvement. The Kaplan-Meier method and log-rank test were then used to assess the effect of MSK involvement on survival outcomes. Results: Of 1042 childhood leukemia cases, 81 (7.8%) children had MSK involvement at initial presentation. MSK involvement was more likely in children with acute lymphoblastic leukemia than acute myeloid leukemia (p <0.05). Hematologic abnormalities were less frequent in the MSK involvement group (p <0.05). The absence of peripheral blast cells was significantly higher in the MSK involvement group (17.3% vs 9.6%, p = 0.04). Normal complete blood counts with absence of peripheral blast cells were found 2.5% of the children with MSK involvement. By propensity score-matching for comparable risk groups of children with and without MSK involvement, the 5-year overall survival was not significantly different (48.2% vs 57.4%, respectively, p = 0.22), nor was event-free survival (43.3% vs 51.8%, respectively, p = 0.31). Conclusion: Childhood leukemia with MSK involvement had the characteristics of minimal or absent hematologic abnormalities and peripheral blast counts.
Background. Studies on the long-term treatment outcomes of childhood acute lymphoblastic leukemia (ALL) in resource-limited countries are scarce. The purpose of this study was to assess the evolution of survival outcomes of pediatric ALL in a tertiary care center in Thailand over a 40-year period. Patients and methods. We retrospectively reviewed the medical records of pediatric patients who were diagnosed with ALL and treated at our center between June 1979 and December 2019. We classified the patients into 4 study periods depending on the therapy protocol used to treat the patients (period 1: 1979-1986, period 2: 1987-2005, period 3: 2006-2013, and period 4: 2014-2019). The Kaplan Meier method was used to determine overall and event-free survival for each group. The log-rank test was used to identify statistical differences. Results. Over the study period, 726 patients with ALL were identified, 428 boys (59%) and 298 girls (41%), with a median age at diagnosis of 4.7 years (range: 0.2–15 years). The study periods 1, 2, 3, and 4 had 5-year event-free survival (EFS) rates of 27.6%, 41.6%, 55.9% and 66.4%, and 5-year overall survival (OS) rates of 32.8%, 47.8%, 61.5%, and 69.3%, respectively. From period 1 to period 4, both the EFS and OS rates increased significantly (p<0.0001). Age, study period, and white blood cell (WBC) count were all significant prognostic indicators for survival outcomes. Conclusions. The overall survival of patients with ALL treated in our center improved significantly over time from 32.8% in period 1 to 69.3% in period 4.
BACKGROUND: Few studies have examined survival in relapsed childhood acute lymphoblastic leukemia (ALL) in resource-limited countries. The aims of this study were to evaluate the incidence, prognostic factors, and survival of relapsed childhood ALL in Thailand. METHODS: The medical records of patients with ALL aged <15 years in the major tertiary care institution in Southern Thailand between January 2000 and December 2019 were retrospectively reviewed. The Kaplan-Meier method was used to depict the overall survival (OS). RESULTS: A total of 472 patients with ALL were enrolled. The incidence of relapsed ALL was 32.8%. Of the 155 relapsed patients, 131 (84.5%) and 24 (15.5%) had B-cell and T-cell phenotypes, respectively. One hundred thirteen (72.9%) and 42 (27.1%) patients had early and late relapses, respectively. The most common site of relapse was bone marrow in 102 patients (65.8%). One hundred twenty-eight (82.6%) and 27 (17.4%) patients received or refused the relapse chemotherapy, respectively. The 5-year OS of all relapsed patients was 11.9%. The 5-year OS among the patients with early relapse was significantly lower than in the patients with late relapse (5.3% vs. 29.1%, respectively, p <0.0001). Site and immunophenotype were not associated with survival of relapsed ALL. The patients who refused chemotherapy had a median survival time of 3.1 months. CONCLUSION: The relapse rate was one third of patients with ALL. The 5-year OS was 12% and patients who refused chemotherapy had a median survival time of 3 months.