# Prevalence and Treatment Outcomes of Childhood Acute Lymphoblastic Leukemia in Kosovo

## TL;DR

This study reports on childhood ALL in Kosovo over 15 years, showing lower survival rates than global averages and highlighting the need for better diagnostics and treatment strategies.

## Contribution

The first comprehensive report on ALL in Kosovo, revealing survival rates and the potential impact of genotyping and drug monitoring.

## Key findings

- 55% of patients achieved 2-year event-free survival, and 40% achieved 5-year event-free survival.
- The AIEOP-BFM-2009 protocol achieved an 88% 5-year overall survival rate, showing the benefit of standardized treatment.
- A 20% mortality rate was observed, with significant survival differences across risk groups.

## Abstract

This is the first report portraying the situation of childhood acute lymphoblastic leukemia (ALL) in Kosovo over the past 15 years. We examine treatment protocols, remission and relapse rates, and 2-year and 5-year event-free survival (EFS) and overall survival (OS) rates. In our study cohort, 55% of patients achieved 2-year EFS, 40% achieved 5-year EFS, 61% achieved 2-year OS, and 46% achieved 5-year OS, which are lower rates compared to most other studies. These findings emphasize the importance of genotyping for common polymorphisms and therapeutic drug monitoring, which have not been utilized to date, as foundational methods among healthcare providers treating childhood ALL in Kosovo.

Advances in research, including novel biomarker identification and patient stratification, have significantly improved the therapy for childhood acute lymphoblastic leukemia (ALL), though access to improved healthcare services varies across geographical regions. In an effort to evaluate the advances in therapeutic approaches, we performed a retrospective analysis of childhood ALL in Kosovo. Our retrospective analysis included 225 cases diagnosed between 2008 and 2023, representing 52% of 429 diagnosed childhood cancers. The average annual incidence was 14, with a median age diagnosis of seven years, and a male predominance (59.54%). Patients were categorized into risk groups, with the majority (43%) in the standard-risk category. We identified five different treatment protocols for this study period. Over 61% of patients achieved remission after the first chemotherapy cycle and we observed a 20% mortality rate. Survival analysis showed that 55% and 40% of patients achieved 2-year and 5-year event-free survival (EFS), respectively, with significant differences across risk groups. Treatment advancements significantly correlated with improved survival rates, achieving a 5-year overall survival (OS) of 88% in the currently used standardized AIEOP-BFM-2009 protocol. Our study emphasizes the need for continued research and customized care strategies to enhance clinical outcomes.