Role of socioecological factors and presenting features in the outcome of local children suffering from acute lymphoblastic leukemia

A prospective study was conducted from may 2001 to june 2006 children with acute lymphoblastic leukemia (all) under treatment to assess the role of different socio-ecological factors on disease outcome. only ninety eight of the total blood cancer patients attending the hospital suffered from acute lymphoblastic leukemia. however,only 62 of these consented to participate in the study. four abandoned the study at initial stages and 10 patients died,leaving 48 subjects who completed the study (2-18 years of age). according to different treatment protocols,they were divided into three main groups. the 1st group received daunorubicin,vincristine and prednisolone as induction therapy. the 2nd group received additional l-asparaginase enzyme while the 3rd group received powdered nigella sativa seeds in place of l-asparaginase for the first 6 months. the maintenance therapy following induction was the same in all 3 groups. the age,sex,religion,socioeconomic status,presenting symptoms,signs,geographic distribution and cell morphologic subtypes were recorded at the start of the study. the variables including symptoms and signs in different groups were recorded after every 15 days for 6 months,monthly for next 6 months and then every 3 months during the remaining period of study. the data revealed that complete remission rate (cr) was 82.7%,having a marked survival difference with age,sex,and morphologic subtypes. high cr and good prognosis was noted for the younger group,but no sex differences were found and relatively better prognosis was in l1 subtype than in l2 and l3 types. the l2 and l3 morphologic subtypes showed bad prognosis and 17.3% were refractory and died during study. no difference was recorded for religious groups. the common symptoms of the disease were fever,weight loss and bleeding while common findings were organ enlargements like lymphadenopathy and/or hepatospleenomegaly. it was thus evident that prognosis of acute lymphoblastic leukemia in children was bad as age advanced,the subjects showing signs of organ enlargement and l2 and l3 morphology. the geographic distribution also seems to play a role as cases were more from industrial areas. the relationship with regard to sex,religion and socioeconomic status was not significant.