[The Factors Related to Treatment Failure in Children with Acute Lymphoblastic leukemia--Analysis of Multi-Center Data from Real World in Fujian Province]

Objective: To analyze the related factors of treatment failure in children with acute lymphoblastic leukemia (ALL) in real-world.

Methods: The clinical data of 1414 newly diagnosed children with ALL admitted to five hospital in Fujian province from April 2011 to December 2020 were retrospectively analyzed. Treatment failure was defined as relapse, non-relapse death, and secondary tumor.

Results: Following-up for median time 49.7 (0.1-136.9) months, there were 269 cases (19.0%) treatment failure, including 140 cases (52.0%) relapse, and 129 cases (48.0%) non-relapse death. Cox univariate and multivariate analysis showed that white WBC≥50×10⁹/L at newly diagnosis, acute T-cell lymphoblastic leukemia (T-ALL), BCR-ABL1, KMT2A-rearrangement and poor early treatment response were independent risk factor for treatment failure (all HR＞1.000, P < 0.05). The 5-year OS of 140 relapsed ALL patients was only 23.8%, with a significantly worse prognosis for very early relapse (relapse time within 18 months of diagnosis). Among 129 patients died from non-relapse death, 71 cases (26.4%) were died from treatment-related complications, 56 cases (20.8%) died from treatment abandonment, and 2 cases (0.7%) died from disease progression. Among them, treatment-related death were significantly correlated with chemotherapy intensity, while treatment abandonment were mainly related to economic factors.

Conclusion: The treatment failure of children with ALL in our province is still relatively high, with relapse being the main cause of treatment failure, while treatment related death and treatment abandonment caused by economic factors are the main causes of non-relapse related death.