| Abstract [eng] |
Acute lymphoblastic leukemia (ALL) is one of the most common malignant tumors among children and adolescents, accounting for approximately 25% of all childhood cancers. About 90% of pediatric patients get cured, but 10–15% experience a relapse. The 5-year survival of relapse decreases significantly, reaching only approx. 50% (1). Even in large international study cohorts, it has not improved significantly and remains one of the leading causes of death from childhood cancer (1). The aim of this study is to evaluate the treatment outcomes of childhood acute lymphoblastic leukemia relapses at Vilnius University Hospital Santaros Klinikos (VULSK), Center for Pediatric Oncology and Hematology from 1992 to 2025. Objectives – to compare patient survival rates between two time periods, 1992-2008 (T1) and 2009-2024 (T2), to evaluate the benefits of innovative therapies and to assess the effectiveness of allogeneic hematopoietic stem cell transplantation after incorporating them into the treatment regimen for ALL relapses. Methodology. The study involved a literature review and a retrospective clinical data analysis. Patient data were analyzed using IBM SPSS using descriptive statistical methods. Results and conclusions. Comparing time periods, T1 and T2, patient survival in Lithuania has improved over the years, currently, 5-year survival of relapses is 59%. Nevertheless, the most common causes of death remain disease progression (42,3%) and infectious complications (32,4%). Although only a small number of patients (12/102) until now have been treated with innovative therapy – blinatumomab and nelarabine – results of the research showed that the use of these medications improves the disease’s response to treatment and allows a larger number of children to achieve complete remission. The analyzed data reflect improvement of ALL treatment’s results in Lithuania since the beginning of independence when poor treatment outcomes were associated not only with the aggressive course of the disease but also a lack of diagnostic and treatment options. The limited availability of immunophenotyping and cytogenetic analysis caused not sufficiently precise stratification into treatment’s risk groups. In addition to that, patients frequently were treated with the drugs available at the time. Currently relapse protocols are tailored to the level of relapse risk, and treatment utilizes worldwide recognized drugs. Such advances in diagnostic and treatment options, along with disease risk classification, have markedly improved treatment outcomes. Nevertheless, mortality from relapses remains a concern, indicating the need to seek better with treatment related mortality prevention and management, early detection and new effective treatment therapies’ discovery. |
