The comparison of outcome and cost of three protocols for childhood non-high risk acute lymphoblastic leukemia in China.
OBJECTIVE
To compare the outcome and treatment cost of three protocols for childhood non-high risk acute lymphoblastic leukemia (ALL), and evaluate the feasibility of less intensive treatment protocol for low income families.


METHODS
Two hundred forty-three children were newly diagnosed ALL in a university hospital from May 1999 to August 2006. Three protocols were offered to the patients: China-98 protocol, or modified ALLIC BFM2002 protocol, or an in-house Reduced Intensity Protocol (or also known as Economic Protocol).


RESULTS
Among 243 patients, 19 abandoned treatment, 3 transferred to other hospitals, 48 were high-risk and were treated with the high risk protocol, and 4 had mature B-ALL. A total of 169 cases were enrolled on non-high risk protocols: 46 treated on China-98 protocol, 73 on modified ALLIC BFM2002 and 50 from low income families on Economic Protocol. The event-free survival (EFS) at 4 years was 80.4% (95%CI, 68.8-92.2%), 83.5% (95%CI, 73.5-93.5%), and 72.8% (95%CI, 59.3-86.3%) for China-98 protocol, modified ALLIC BFM2002, and Economic Protocol respectively. The hospitalization costs (range and median) were significantly different between protocols: US$ 8,700-25,500 (12,500), US$ 6,900-16,400 (9,900), US$ 3,100-6,800 (4,300) for China-98 protocol, modified ALLIC BFM2002, and Economic Protocol respectively.


CONCLUSIONS
This report from China has systematically reviewed the outcome and costs of protocols for ALL having different dose intensity. The reduced intensity protocol appears to achieve reasonable EFS (72.8% at 4 years) for non-high risk ALL at a much lower cost. This is especially important for low income families in developing countries.
Luo
Xue-Qun
XQ
Department of Pediatrics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Ke
Zhi-Yong
ZY
Guan
Xiao-Qing
XQ
Zhang
Ying-Chuang
YC
Huang
Li-Bin
LB
Zhu
Jia
J
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D018805:Sepsis / Q000453:epidemiology; D016896:Treatment Outcome