Tendência secular da sobrevida por leucemia linfoide aguda em crianças de baixo nível socioeconômico do Nordeste do Brasil

Abstract

Introduction: Acute Lymphoid Leukemia (ALL) is a multifactorial disease that accounts for 75% of leukemia in childhood. Despite the therapeutic advances in recent decades, developing countries remain with low survival rate, not reaching 35%, no corroborating data from developed countries where this rate reaches 85%. There are numerous obstacles to treatment in developing countries. But even when the appropriate treatment is available, socioeconomic disparities, represented by the difficulty in access to adequate health services especially in rural areas, result in reduced survival rates. The objective of this study was to evaluate the secular trend of survival for ALL in children living in Sergipe state in northeastern Brazil, and its association with socioeconomic status Methods and results: Rated 401 patients up to 19 years of age, divided in 3 cohorts with a confirmed diagnosis of ALL. Family income was considered and mother's education or primary caregiver for the classification of socioeconomic level, in addition to housing conditions. Overall survival, estimated at 5 years was significantly higher in stratified as low risk patients (69.8%, p = 0.030), residing in urban areas (59.6%, p = 0.025) and use treated water (60 3%, p = 0.041). Regarding the death related to toxicity of treatment the infection was the most common cause of treatment failure in cohort B (27.8%), occurring more frequently in the induction (22.7%). The overall mortality was significantly higher in high-risk patients, family income was not statistically significant on mortality and overall survival. Conclusion: Infection is the leading cause of death in patients with LLA studied. Patients enrolled in a public, living in a rural area and do not use treated water had the worst results, showing the influence of socioeconomic factors in the outcome. There was no relationship between education of caregivers or family income and mortality, possibly because they were those very homogeneous variables in the sample.