Evaluation of Prognostic Factors in Children With Acute Lymphoblastic Leukemia Publisher



Yousefian MS ; Manoochehri MM
Source: Iranian Journal of Pediatric Hematology and Oncology Published:2026

Abstract

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Despite major therapeutic advancements, relapse and treatment failure continue to be serious challenges, particularly in low- and middle-income countries. While several well-established prognostic factors such as age, white blood cell (WBC) count, cytogenetic abnormalities, minimal residual disease (MRD), and socioeconomic status (SES) have been validated in high-income regions, limited evidence is available from developing countries. Therefore, this study aimed to investigate the prognostic factors associated with relapse and mortality in children diagnosed with ALL in a developing country setting. Materials and Methods: This prospective cohort study included 130 children younger than 15 years with confirmed ALL admitted to a tertiary referral center from 2014 to 2020. Demographic, clinical, laboratory, MRD, genetic, and socioeconomic data were collected from the patients, and they were followed for up to 48 months after achieving remission. Univariate and multivariate Cox regression models were used to identify the independent predictors of relapse and mortality (significance threshold: p < 0.05). Results: The mean age of the participants was 4.76 ± 3.36 years, and relapse or death occurred in 31 (23.8%) of them. The univariate analysis showed that older age, MRD > 0.1% on day 33, and higher hemoglobin level were associated with relapse. The multivariate analysis identified MRD > 0.1% on day 33 as the only significant independent predictor of relapse. A survival analysis via a multivariate Cox-regression model also showed a lower income level (HR = 2.150, p = 0.033) associated with a higher mortality. Conclusion: This study reveals MRD on day 33 as the strongest determinant of relapse and highlights the critical role of socioeconomic disparities in mortality among children with ALL in developing countries. Early MRD-based risk stratification and policies aimed at bridging socioeconomic gaps may contribute to improved survival outcomes. Larger multicenter studies and extended molecular profiling are recommended. © (2026), (Shahid Sadoughi University of Medical Sciences). All rights reserved.