P-0071 Reasons for early abondonment of treatment in children with acute lymphoblastic leukemia in a low middle income country

Document Type



Haematology/Oncology; Paediatrics and Child Health


Purpose/Objective: In contrast to the resource-rich countries with cure rate of over 80% for children with Acute Lymphoblastic Leukemia (ALL), survival rates in developing countries are significantly lower. Abandonment of treatment has been identified as a major contributor of therapeutic failure. This study describes the predictors of early abandonment of chemotherapy in pediatric ALL patients in a developing country setting.
Materials and Methods: We conducted a multi-center prospective cohort study at 3 major pediatric cancer centers in Karachi from September 1st, 2009 to August 31st, 2012. 625 patients with ALL were enrolled and followed for 36 months. Telephone interviews were done of those who were lost to follow-up (LTFU) to ascertain reasons for LTFU despite the treatment being available at no cost at two of the hospitals.
Results: A total of 128 (20%) patients were LTFU, 38 before start of therapy, 44 during induction phase and 46 after induction. Factors significantly associated with LTFU at univariate level were age less than one year (OR=3.56, p-value=0.039), residence out of Karachi city (OR=2.32, p-value=0.001), no paternal education (OR=3.29, p-value<0.001), no maternal education (OR=3.01, p-value<0.001) and non-Urdu speaking ethnicity (OR=1.44, p-value<0.01). Gender, welfare support and type of ALL were not associated with LTFU. The most common reasons given by primary caretakers on phone interview were, sudden death of child at home, distance from the hospital, non-medical costs, alternative treatments, the need to take care of other children at home and progression of disease.
Conclusions: Parental education, distance from home and younger age are identified as variables associated with a risk for treatment abandonment. Caregivers identified non-medical financial constraints and family concerns as major reasons. Further investigation and establishment of mechanisms for alleviating these may help reduce treatment abandonment of ALL patients in Karachi.


This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Pediatric Blood & Cancer