Clinical outcomes in pediatric acute lymphoblastic leukemia: a retrospective cohort study from a tertiary center in Indonesia

Abstract

Introduction Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy, accounting for approximately 80% of childhood acute leukemia cases. Despite substantial improvements in survival in high-income countries, outcomes in Indonesia remain suboptimal. Methods This retrospective cohort study analyzed medical records of pediatric ALL patients treated at Dr. Mohammad Hoesin General Hospital, Palembang, from 2019 to 2023 to describe demographic, clinical, laboratory, and immunophenotypic characteristics and their association with overall survival. Results Most patients were aged 1–10 years, male, and had normal nutritional status, with leukocyte counts <50,000/µL, thrombocytopenia, and no central nervous system involvement or mediastinal mass. B-lineage ALL predominated. Univariate survival analysis showed that age at diagnosis, nutritional status, mediastinal mass, leukocyte count, and risk stratification were significantly associated with overall survival, whereas immunophenotypic classification was not. Multivariate Cox regression identified age >10 years and poor nutritional status as independent predictors of poorer overall survival. Conclusion These findings underscore the importance of early diagnosis and nutritional optimization to improve overall survival in pediatric ALL.