Delayed diagnostic interval and survival outcomes in pediatric leukemia: A single-center, retrospective study
Corresponding Author
Kosuke Tamefusa
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Correspondence
Kosuke Tamefusa, Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
Email: [email protected]
Search for more papers by this authorMotoharu Ochi
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorHisashi Ishida
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorTakahiro Shiwaku
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorKiichiro Kanamitsu
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan
Search for more papers by this authorKaori Fujiwara
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorYasuhisa Tatebe
Department of Pharmacy, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorNaomi Matsumoto
Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
Search for more papers by this authorKana Washio
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorHirokazu Tsukahara
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorCorresponding Author
Kosuke Tamefusa
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Correspondence
Kosuke Tamefusa, Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
Email: [email protected]
Search for more papers by this authorMotoharu Ochi
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorHisashi Ishida
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorTakahiro Shiwaku
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorKiichiro Kanamitsu
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan
Search for more papers by this authorKaori Fujiwara
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorYasuhisa Tatebe
Department of Pharmacy, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorNaomi Matsumoto
Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
Search for more papers by this authorKana Washio
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorHirokazu Tsukahara
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Department of Pediatrics, Okayama University Hospital, Okayama, Japan
Search for more papers by this authorAbstract
Objective
This study primarily focused on the diagnostic interval (DI), defined as the duration from the onset of leukemic symptoms to diagnosis. We investigated whether a prolonged DI is associated with the outcomes of pediatric leukemia.
Methods
We retrospectively collected data of children with newly diagnosed pediatric leukemia at Okayama University Hospital from January 2007 to December 2022. Survival analyses were conducted using Kaplan–Meier methods, and an unadjusted analysis to compare differences in survival was performed using the log-rank test.
Results
In total, 103 children with leukemia were included in the analysis. The median DI was 20 days (interquartile range, 9.5–33.5 days). A prolonged DI (≥30 days) demonstrated no association with either 5-year event-free survival (70.1% for <30 days and 68.3% for ≥30 days, p = .99, log-rank test) or overall survival (84.7% for <30 days and 89.4% for ≥30 days, p = .85, log-rank test).
Conclusions
A prolonged DI was not associated with the survival of children with leukemia. If a precise classification of leukemia biology is provided for pediatric patients, a prolonged DI may have little impact on the prognosis of these patients.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
| Filename | Description |
|---|---|
| ejh14162-sup-0001-FigureS1.tiffTIFF image, 355.4 KB | Figure S1. Dot plots represent the distributions of the (A) patient interval, (B) physician interval, (C) diagnostic interval, and (D) treatment interval in our cohort. |
| ejh14162-sup-0002-FigureS2.tiffTIFF image, 329.3 KB | Figure S2. Comparison of EFS and OS between patients with a prolonged DI and those with a standard DI. We defined a prolonged DI as ≥20 days. (A) EFS of children with leukemia. (B) OS of children with leukemia. (C) EFS of children only with ALL. (D) OS of children only with ALL. ALL, acute lymphoblastic leukemia; DI, diagnostic interval; EFS, event-free survival; OS, overall survival. |
| ejh14162-sup-0003-FigureS3.tiffTIFF image, 308 KB | Figure S3. Comparison of EFS and OS between patients with a prolonged PI and those with a standard PI. We defined a prolonged PI as >7 days. (A) EFS of children with leukemia. (B) OS of children with leukemia. (C) EFS of children only with ALL. (D) OS of children only with ALL. ALL, acute lymphoblastic leukemia; EFS, event-free survival; OS, overall survival; PI, physician interval. |
| ejh14162-sup-0004-FigureS4.tiffTIFF image, 227.2 KB | Figure S4. Comparison of EFS stratified by a TI of 0–5 days or longer. (A) EFS of children with leukemia and (B) EFS of children with ALL. ALL, acute lymphoblastic leukemia; EFS, event-free survival; TI, treatment interval. |
| ejh14162-sup-0005-FigureS5.tiffTIFF image, 238.8 KB | Figure S5. (A) Comparison of EFS between low-risk patients with ALL and a standard DI and those with a prolonged DI. (B) Comparison of EFS between non-low-risk patients with ALL and a standard DI and those with a prolonged DI. We defined a prolonged DI as ≥30 days. ALL, acute lymphoblastic leukemia; DI, diagnostic interval; EFS, event-free survival. |
| ejh14162-sup-0006-Tables.xlsxExcel 2007 spreadsheet , 34 KB | Table S1. Summary of available clinical information of study cohort. HSCT, hematopoietic stem cell transplantation; ICU, intensive care unit; LDH, lactate dehydrogenase; Plt, platelet; WBC, white blood cell. *0, absence of symptom; 1, presence of symptom. †0, spring (March–May); 1, summer (June–August); 2, autumn (September–November); 3, winter (December–February). ‡0, inside Okayama prefecture; 1, outside Okayama prefecture. ¶0, pediatrician; 1, non-pediatrician; 2, data unavailable. **0, Yes; 1, No. Table S2. Clinical details of patients who needed ICU admission around treatment induction. ALL, acute lymphoblastic leukemia; BCP-ALL, B-cell precursor acute lymphoblastic leukemia; CHDF, continuous hemodiafiltration; Cre, creatinine; F, female; ICU, intensive care unit; JMML, juvenile myelomonocytic leukemia; K, potassium; LDH, lactate dehydrogenase; M, male; P, phosphorus; T-ALL/T-LL, T-cell acute lymphoblastic leukemia and lymphoblastic lymphoma; TLS, tumor lysis syndrome; UA, uric acid; WBC, white blood cell. Table S3. Intervals in days according to each variable. Data are shown as n, n (%), or median (interquartile range). HSCT, hematopoietic stem cell transplantation; ICU, intensive care unit. Table S4. Relationships between symptoms and intervals. Data are shown as n, n (%), or median (interquartile range). |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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