Taking advantage of these facts, it is reasonable to assume that treating the competing events as censored observation and using the Kaplan-Meier method is an erroneous and inappropriate estimate in this setting. As the death of some participants occurs before relapse, time to relapse cannot be evaluated accurately due to inappropriate estimation of the risk of relapse an event which is known as competing risk, in which the occurrence of one event masks the occurrence of another ( 7). Adding to this complexity, tumor lysis syndrome (TLS) is another severe and life-threatening complication that contributes to progress disease toward an unfavorable outcome, at least partly, through the electrolyte and metabolic disturbances leading to cardiac arrhythmia, seizure, multi-organ failure, and eventually death ( 5).ĭespite the evidence, attest stating the survival analysis retains a specific clinical and biological significance in patients with ALL ( 6), an important challenge relevant to these studies is the fact that “time to relapse” is susceptible to bias. Although risk-adapted chemotherapy is conventionally accepted as an efficient therapeutic approach in pediatric with ALL in Iran, some of the patients, who are not considered ‘high-risk’ and treated accordingly, would relapse after initially successful treatment with an approximate morbidity and mortality rate of 58% ( 4). Notwithstanding copious studies to improve disease outcomes, efforts have not yet converted into a better prospect and bone marrow relapse is still the leading cause of person-year of life lost in this malignancy ( 3). With an overall incidence of about 1 to 2 in 100 000 person-year in children, acute lymphoblastic leukemia (ALL) is the most frequent form of malignant neoplasia diagnosed in ages 0 to 14 years old ( 1, 2). Mortality Acute Lymphoblastic Leukemia Relapse Survival Analysis 1. However, further evaluation on the larger population of patients is demanded to ascertain the precision of such parameters in leukemic management strategies. It was suggested that TLS was a predictor for the disease relapse as well as mortality in pediatric patients with ALL.
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