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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 maintenance 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%). Sixtyfive (21%), 133 (43%) and 110 (36%) patients belonged to groups 1, 2 and 3. Sixteen patients abandoned treatment. The incidence of abandonment did not differ significantly between the 3 groups (p1⁄40.305). Neutropenic deaths occurred in 19 patients during maintenance therapy. However, maintenance deaths were similar among the 3 groups (p 1⁄4 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% (p1⁄40.557, Fig. 1). Overallsurvival (OS) did not differ between groups 1,2 and 3: 76.4±6.2%, 75.3±3.8% and 73.4±4.6% (p1⁄40.810). EFS and OS did not differ between rural and urban patients (54.5±3.9% vs. 64.6±5%, p1⁄40.166; 73.6±3.3% vs. 76.6±4.7%, p1⁄40.524). 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

pediatric hematology oncology journal

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