Factores asociados a recaídas en pacientes con leucemia linfoblástica aguda en niños de 2 a 10 años en el Hospital del Niño Dr. Francisco De Icaza Bustamante, periodo 2022-2024.

Abstract

Introduction: acute lymphoblastic leukemia (ALL) is the most common hematologic malignancy in childhood and accounts for 75 % of pediatric leukemias. Various clinical and biological factors present at diagnosis influence treatment response and the risk of relapse, which remains one of the main challenges affecting patient prognosis. Objective: to evaluate the factors associated with relapses in children aged 2 to 10 years diagnosed with acute lymphoblastic leukemia at Dr. Francisco De Icaza Bustamante Children´s hospital during the period 2022-2024. Methodology: an observational, retrospective, analytical, case-control study including 260 patients with ALL. Sociodemographic, clinical, biological, and therapeutic variables were analyzed. Associations were estimated using odds ratios and ratios and 95 % confidence intervals, with p<0.05 considered statistically significant. Results: sixty-eight patients (26.6 %) experienced relapse. Factors significantly associated with relapse included age 5.7 years (or=15), Age 8.10 years (OR=13.42), male sex (OR=2.19), greater distance from the hospital, high-response (OR=22.85), M2 bone marrow status (OR=9.15) and M3 bone marrow status (OR=22), detectable MRD, poor-prognosis chromosomal abnormalities (OR=6.02), and lack of treatment adherence (OR=13.29). Bone marrow was the main site of relapse (66.2%) and it resulted in an overall mortality rate of 13.1%. Conclusion: pediatric ALL relapses exhibited a multifactorial pattern mainly associated with risk characteristics at diagnosis, unfavorable treatment response, persistent disease, and lack of adherence. Early identification of these factors may help strengthen risk stratification, follow-up, and treatment continuity.