Evaluation and Diagnosis of Prognostic Factors Affecting the Survival of Leukemia Patients Using Cumulative Incidence Function

Background: Acute lymphoblastic leukemia (ALL) accounts for 25% of cancers among children less than 15 years of age. This study aimed to evaluate and determine the prognostic factors affecting the survival of leukemia patients using cumulative incidence function.Method: This was a retrospective study done on 176 children under 15 who had ALL between 2011 and 2019. Overall survival, event-free survival, disease-free survival (DFS), and non-relapse mortality served as the study's endpoints. Using the Fine-Gray model, the Kaplan-Meier, single-variable, and multivariable analyses were conducted. Schwenfeld weighted residuals were used to test the proportional hazard hypothesis. SAS was used to conduct the analysis.Results: The hazard ratio (HR) of DFS for effective variables was calculated (girls compared to boys: 0.37 [95% confidence interval (CI): 0.15-0.91], positive testis test: 10.34 [95% CI: 4.44-24.05], children with central nervous system involvement: 2.95 [95% CI: 1.36-6.40], testicular swelling in children: 11.54 [95% CI: 4.21-31.59], children with hepatosplenomegaly larger than 2 cm: 0.30 [95% CI: 0.10-0.88], high risk of disease compared to low risk: 4.76 [95% CI: 1.12-20.22], children with complete remission in 28th day compared with no complete remission: 0.10 [95% CI: 0.04- 0.25]. Only hemoglobin was substantially linked with DFS in the multivariate DFS HR. Children who got radiation had a 77% reduced risk of non-recurrence death than those who did not (HR: 0.23, 95% CI: 0.08-0.60).Conclusion: Being a girl, having family history, and not having radiotherapy were the main factors to develop death before the first recurrence in children.