Amita Trehan

Appinderjit Kaur

Deepak Bansal

Richa Jain

Sidharth Totadri

Pediatric Hematology Oncology Journal

Directory of Open Access Journals

Does distance between residence and treating center impact outcome in childhood acute lymphoblastic leukemia? Report from a tertiary care center in North India

Totadri, Sidharth

Trehan, Amita

Kaur, Appinderjit

Bansal, Deepak

Jain, Richa

Elsevier - Publisher Connector 

Figure 1. Event free survival of patients belonging to areas < 50 km, 50-200 km and >
200 km from treating center (Chandigarh).
Figure 1. Event free survival in children belonging to upper, middle and lower so-
cioeconomic (SE) strata, after excluding patients who died in induction.
Abstracts / Pediatric Hematology Oncology Journal 1 (2016) S1eS33 S11LM-1_V1.14
DOES DISTANCE BETWEEN RESIDENCE AND TREATING CENTER IMPACT
OUTCOME IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA?
REPORT FROM A TERTIARY CARE CENTER IN NORTH INDIA
Sidharth Totadri, Amita Trehan, Appinderjit Kaur, Deepak Bansal, Richa
Jain. PGIMER, Chandigarh, India
Background: Patients in our country often live far from the oncology
center. Amongst the numerous socio-demographic factors which affect
outcome, it is postulated that outcome may have a relationship to the
proximity of the patient to the tertiary care center.
Aim: To study if distance between home and the treating center inﬂuenced
outcome in childhood acute lymphoblastic leukemia (ALL).
Methods: A retrospective analysis of children diagnosed and treated for
ALL from January 2010 to December 2012 were included. Patients were
treated as per modiﬁed UKALL-2003 protocol. Details of residential
address were noted from the database maintained by the social worker.
Patients were instructed to stay within an hour's distance of hospital till
the completion of delayed intensiﬁcation phase of therapy. During main-
tenance therapy, they visit the oncology centermonthly from their place of
residence. Distance between Chandigarh and district of residence of the
patient was recorded. Patients were classiﬁed based on this distance in
kilometers (km) into 3 groups; group 1: 0-50 km, 2: 50-200 km, 3: > 200
km. Induction failure, death and relapse were included as events for
Kaplan-Meier survival analysis.
Results: The study included 308 patients with median age of 5 years
(range: 1-13). Male to female ratio was 2.5:1. Numbers of patients
hailing from rural and urban areas were 198 (64%) and 110 (36%). Sixty-
ﬁve (21%), 133 (43%) and 110 (36%) patients belonged to groups 1, 2 and
3. Sixteen patients abandoned treatment. The incidence of abandon-
ment did not differ signiﬁcantly between the 3 groups (p¼0.305).
Neutropenic deaths occurred in 19 patients during maintenance ther-
apy. However, maintenance deaths were similar among the 3 groups (p
¼ 0.409). Event-free-survival (EFS) in groups 1,2 and 3 was not
different: 63.7±6.6%, 57.8±4.6% and 55.1±5.4% (p¼0.557, Fig. 1). Overall-
survival (OS) did not differ between groups 1,2 and 3: 76.4±6.2%,
75.3±3.8% and 73.4±4.6% (p¼0.810). EFS and OS did not differ between
rural and urban patients (54.5±3.9% vs. 64.6±5%, p¼0.166; 73.6±3.3% vs.
76.6±4.7%, p¼0.524).
Conclusions: Distance between patients' residence and the treating center
does not impact survival in childhood ALL. Patients hailing from rural and
urban backgrounds do not differ in their survival.LM-1_V1.15
PROFILE OF INFECTIONS DURING INDUCTION CHEMOTHERAPY IN
CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA
Binitha Rajeswari, K.S. Reghu, C.S. Guruprasad, T. Priyakumari,
P. Kusumakumary. Division of Pediatric Oncology, Regional Cancer Centre,
Thiruvananthapuram, India
E-mail address: drbinithar@gmail.com (B. Rajeswari).
Background: Infections are a major cause of mortality and morbidity in
pediatric ALL patients especially during induction chemotherapy. We
present the proﬁle of infections among 227 consecutive patients who
presented with ALL during an 18- month period. Information on the
clinical and microbiological proﬁle of infections is very important in the
counseling, management and prognostication of patients with ALL.
Objective: To describe the clinical andmicrobiological proﬁle, treatment and
outcome of infections during induction chemotherapy in childrenwith ALL.
Method: This was a prospective observational study. All children (Age: 1 e
14 years) newly diagnosed to have ALL and seeking the services of the
Pediatric oncology division at our Center during the study period were
included. Induction chemotherapy was administered as per a modiﬁed
BFM protocol, for all.
Observations: 227 patients (144 belonged to high risk category and 83
belonged to standard risk category) were enrolled during the study period
(January 2014 to June 2015). There were 150 episodes of infection which
occurred among 117 patients. Major sites were lung (n¼35) and GIT (n¼30).
No deﬁnite focus of infection was evident in 28%. Blood cultures were
positive in 45 episodes (30.6%). Isolates were gram negative organisms
(n¼36; 80%) in the majority in whom culture was positive. Five of the iso-
lates were fungal out of which twowere in combinationwith Pseudomonas.
127 episodes were initially treated with ﬁrst line antibiotics, 19 episodes
with second line antibiotics and 4 episodes with third line antibiotics
based upon the severity of infection. Eventually, 127 episodes received ﬁrst
line, 47 episodes received second line and 28 episodes received third line
antibiotics as per institutional protocol. Antifungals were given in 29 ep-
isodes (19.3%). 24 among them were empirical and the rest based on
positive culture reports. Intensive supportive care in the form of inotropes
or mechanical ventilation was required in 17 episodes (11.3%).
One hundred and thirty six (90.6%) episodes resolved without sequelae.
Twelve patients (8%) died (One of them had varicella with hepatitis and


Does distance between residence and treating center impact outcome in childhood acute lymphoblastic leukemia? Report from a tertiary care center in North India 

file:///data/core-remote/dit/data/elsevier/pdf/730/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMjQ2ODEyNDUxNjMwMDgyMQ==.pdf

Does distance between residence and treating center impact outcome in childhood acute lymphoblastic leukemia? Report from a tertiary care center in North India

Abstract

Similar works

Full text

Available Versions

Directory of Open Access Journals

Elsevier - Publisher Connector

Elsevier - Publisher Connector