INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH AND ANALYSIS
ISSN(p in ): 2643-9840, ISSN(online): 2643-9875
Volume 08 Issue 10 Oc obe 2025
DOI: 10.47191/ijm a/ 8-i10-22, Impac Fac o : 8.266
Page No. 5705-5708
IJMRA, Volume 08 Issue 10 Oc obe 2025 www.ijm a.in Page 5705
Time o Diagnosis, Re e al, and he T ea men Ou comes o Pedia ic Pa ien s
wi h Acu e Lymphoblas ic Leukemia in a Te ia y Re e al Cen e in No he n
Luzon, Philippines
F anz Emmanuel J. Isid o, RMT, MD
Baguio Gene al Hospi al and Medical Cen e Depa men o Pedia ic, Baguio Ci y
ABSTRACT: Acu e lymphoblas ic leukemia (ALL) emains he mos common pedia ic hema ologic malignancy and a majo cause
o cance - ela ed dea h in low- and middle-income coun ies. In he Philippines, despi e heal h policies such as he Na ional
In eg a ed Cance Con ol Ac and he Uni e sal Heal h Ca e Ac , su i al ou comes emain subop imal, pa ly due o delays in
diagnosis and ea men ini ia ion. This s udy examined he ime om symp om onse o diagnosis, e e al, and he apy, and
hei associa ion wi h clinical ou comes among pedia ic ALL pa ien s in a e ia y e e al cen e in No he n Luzon. A desc ip i e
c oss-sec ional e iew was conduc ed on 66 pedia ic pa ien s newly diagnosed wi h ALL and admi ed o Baguio Gene al Hospi al
and Medical Cen e be ween 2017 and 2024. P e-diagnos ic symp oma ic in e al (PSI), p e- ea men in e al (PTI), and
ou comes including emission, elapse, abandonmen , o e all su i al (OS), and disease- ee su i al (DFS) we e analyzed using
desc ip i e s a is ics and Kaplan-Meie es ima es. Mos pa ien s we e male (62%) and aged one o nine yea s (71%). B-cell ALL
comp ised 41% o cases, T-cell 17%, and no o he wise speci ied (NOS) 42%. B-cell ALL had he longes median PSI a 21 days,
while T-cell ALL was sho es a 7 days; NOS cases had he longes PTI a 9.25 days. O e all emission was 51.5%, highes among
B-cell ALL (66.7%). T ea men abandonmen was signi ican ly g ea e in NOS cases (28.6%, p<0.001). The h ee-yea OS was 71.2%
and pla eaued h ough se en yea s, while six-yea DFS eached 51.5%, wi h B-cell ALL showing he bes ou comes. Despi e sho e
delays compa ed wi h o he esou ce-limi ed se ings, su i al emained below high-income benchma ks. Imp o ing ea ly
de ec ion, isk-based s a i ica ion, and pa ien na iga ion may help educe abandonmen and enhance su i al.
KEYWORDS: Acu e Lymphoblas ic Leukemia, P e-diagnos ic symp oma ic in e al, P e-T ea men In e al, Diagnosis Delay
I. INTRODUCTION
Acu e lymphoblas ic leukemia (ALL) is an abe an blood cance ma ked by he abno mal mul iplica ion o imma u e lymphoid
p ecu so s in he bone ma ow, ci cula ing blood, and o he body issues. Pedia ic acu e leukemia cons i u es a ound 77% o all
cases, making i he p edominan hema ologic pedia ic cance .
The wo ldwide occu ence a e o childhood acu e lymphoblas ic leukemia (ALL) is app oxima ely 4.32 pe 100,000 child en
(Ga nish D e al 2022). In Sou heas Asia, he equency a e eached 4.58 pe 100,000 child en in 2021 (Hu Y e al 2024). In he
Philippines a o al o 47,684 cases diagnosed wi h ALL om 2015-2024 based on he 10-yea da abase om he Philippine Pedia ic
Socie y Disease egis y. F om 1990 o 2021, middle socio-demog aphic index egions showed an inc easing end in he es ima ed
annual pe cen age change o he incidence a e (1.49) (Hu Y e al., 2024). The su i al a e o kids wi h ALL om esou ce – limi ed
na ions, such as he Philippines, is lowe ( anging om 50-70%) compa ed o high-income coun ies (90%). "Al hough he Na ional
In eg a ed Cance Con ol Ac (NICCA) and he Uni e sal Heal h Co e age (UHC) Ac o 2019 ha e been implemen ed in he
Philippines, acu e leukemia con inues o cause subs an ial mo ali y, wi h app oxima ely 1,700 dea hs epo ed each yea (WHO,
2021). These igu es ocus he c ucial need o s eng hen ea ly inding, imp o e ac ion p o ocols, and expand heal hca e access,
pa icula ly in u al and unde se ed egions.
Ba ie s such as delays in diagnosis, limi ed e e al sys ems, and he high cos o inaccessibili y o ea men con ibu e o poo
ou comes (WHO, 2021; Sampaga e al., 2023; Elhabashy e al., 2023). These challenges ea u e he u gen need o iden i y and
implemen al e na i e s a egies o ea ly de ec ion and imely in e en ion. One c i ical a ea ha emains insu icien ly s udied
is he du a ion om symp om onse o e e al, ini ia ion o chemo he apy, and i s co ela ion wi h ea men ou comes. This
s udy aims o in es iga e hese ime in e als and e alua e hei impac on he clinical ou comes o pedia ic ALL pa ien s. The
Time o Diagnosis, Re e al, and he T ea men Ou comes o Pedia ic Pa ien s wi h Acu e Lymphoblas ic Leukemia
in a Te ia y Re e al Cen e in No he n Luzon, Philippines
IJMRA, Volume 08 Issue 10 Oc obe 2025 www.ijm a.in Page 5706
indings will se e as a ounda ion o de eloping a egionally app op ia e pa ien na iga ion and e e al sys em o imp o e
su i al a es and o e all quali y o ca e. This in es iga ion seeks o e alua e he du a ion om ini ial symp om p esen a ion o
de ini i e diagnosis and commencemen o ea men ., as well as he ou come o pedia ic pa ien s wi h ALL om Janua y 1, 2017,
o Decembe 31, 2024, e e ed o o egis e ed a Baguio Gene al Hospi al and Medical Cen e .
Speci ically, he s udy also in ends o de e mine he ollowing:
1. To iden i y he clinico-demog aphic p o ile o pedia ic pa ien s wi h Acu e Lymphoblas ic Leukemia e e ed o he
Pedia ic Hema ology and Oncology Se ice o Baguio Gene al Hospi al and Medical Cen e in e ms o :
1.1 Age upon diagnosis
1.2 Sex
1.3 Place o O igin
1.4 NCI Risk S a i ica ion (High Risk and S anda d Risk)
1.5 Immunopheno ype (B cell ALL, T cell ALL, ALL No o he wise speci ied
(NOS)
2. To calcula e he P e-diagnos ic symp oma ic in e al and P e-T ea men in e al o pedia ic pa ien s wi h ALL ca ego ized
by immunopheno ype based on he ollowing:
2.1. P e-diagnos ic Symp oma ic In e al (PSI): du a ion om he symp om appea ed o he ime o diagnosis
2.1.1. PSI 1: he ime in e al om symp om onse o i s physician consul o admission
2.1.2. PSI 2: he ime in e al om he i s physician consul o admission o e e al o hema ologis wi h a clinical
imp ession o Acu e Leukemia
2.2. P e-T ea men In e al (PTI): is he ime be ween a diagnosis and he o he i s ea men
2.2.1. PTI 1: he ime in e al om e e al o a pedia ic hema ologis o he ime o diagnosis
2.2.2. PTI 2: he du a ion om he ime o diagnosis o he ini ia ion o ea men (chemo he apy)
3. To iden i y he ea men o pa ien ou comes wi h ALL, ca ego ized by immunopheno ype, who we e diagnosed om
Janua y 1, 2017, o Decembe 31, 2024:
3.2.1 Remission
3.2.2 Induc ion Failu e
3.2.3 Relapse
3.2.4 Los - o- ollow up
3.2.5 Abandonmen o T ea men
3.2.6 O e all Su i al
3.2.7 Disease-F ee Su i al
4. To iden i y he mean o e -all su i al and disease- ee su i al ime in mon hs among he immunopheno ypes (B-ALL, T-
ALL, ALL-NOS).
II. METHODOLOGY
This desc ip i e c oss-sec ional s udy used o al enume a ion o include all eligible pa icipan s. The pa icipan s (n=91) we e
based on he eigh -yea ins i u ional da abase o BGHMC, which only include pedia ic pa ien s, newly bo n o 18 yea s o age,
e e ed o and/o admi ed in BGHMC om Janua y 1, 2017, o Decembe 31, 2024, wi h a inal diagnosis o Acu e Lymphoblas ic
Leukemia, and managed h ough chemo he apy. Pa ien s who we e e e ed o and ans e ed o a di e en ins i u ion, pa ien s
who ha e s a ed chemo he apy om ano he ins i u ion, e used o ini ia e chemo he apy, cha s wi h incomple e eco ds o
needed a iables, and pa ien s wi h como bidi ies and synch onous malignancies we e excluded (n=25). Thus, an o e all 66
pedia ic pa ien s we e in ol ed in his s udy. Da a was ob ained om he pa ien ’s medical cha , bo h w i en and online ia
EMR. These include he (1) clinic-demog aphic p o iles, (2) pa ien ’s his o y o iden i y he ime o symp om onse , (3) da es when
he ollowing labo a o y es s we e done, as bases o he ime o diagnosis: comple e blood coun , pe iphe al blood smea , bone
ma ow aspi a ion mo phology and/ o low cy ome y esul s, and specialized es s such as Fluo escence In Si u Hyb idiza ion
(FISH) o BCR/ABL1 es s. Da es o iming o symp oms o i s consul , o e e al o hema ology-oncology se ice, o he ini ia ion
o ea men we e no ed om he medical eco ds, bo h om OPD and In-pa ien eco ds, o de e mine he ime in e al in days.
T ea men ou comes we e also de e mined in e ms o emission, induc ion ailu e, elapses, loss o ollow-up, abandonmen o
ea men , as well as he o e all longe i y and disease- ee su i al a e.
The p incipal in es iga o collec ed he da a and we e eco ded on a s anda dized da a collec ion shee and subsequen ly
encoded in o a passwo d secu ed sp eadshee a ailable only o he p incipal esea che and he supe ising in es iga o . All da a
Time o Diagnosis, Re e al, and he T ea men Ou comes o Pedia ic Pa ien s wi h Acu e Lymphoblas ic Leukemia
in a Te ia y Re e al Cen e in No he n Luzon, Philippines
IJMRA, Volume 08 Issue 10 Oc obe 2025 www.ijm a.in Page 5707
we e encoded in Mic oso Excel and analyzed using IBM SPSS S a is ics e sion 22.0. Desc ip i e s a is ics using mean and
s anda d de ia ion o median o quan i a i e a iables (demog aphic and clinical cha ac e is ics), and equency and pe cen age
o ca ego ical a iables such as he ea men ou comes o pedia ic pa ien s wi h ALL. The o e all su i al a e (OSR) and e en -
ee su i al (EFSR) a es a i e yea s we e compu ed using he Kaplan-Meie es ima o . Da a collec ed o he OS and EFS includes
he ime se ial yea ly, s a us (ali e, mo ali y, e en s like elapse, abandonmen un il he end o he s udy pe iod which we e
colla ed and subjec ed o analysis. The s udy was au ho ized by he E hics Commi ee o Baguio Gene al Hospi al and Medical
Cen e . All p in ed o w i en ma e ials will be disposed, and digi al iles will be secu ely e ased a e i e yea s. The s udy s ic ly
complied wi h he Da a P i acy Ac o 2012 and Good Clinical P ac ice (GCP) guidelines. Fu he mo e, he Resea che has no
inancial o o ganiza ional ies and he e will be no compensa ion needed. Hence, he e is no con lic o in e es .
III. RESULTS AND DISCUSSIONS
Demog aphics, Diagnos ic In e als, and T ea men Ou comes o Pedia ic ALL Pa ien s
Cha ac e is ic
O e all
B-cell ALL
T-cell ALL
ALL NOS
Pa ien s, n (%)
66 (100)
27 (40.9)
11 (16.7)
28 (42.4)
Male sex, n (%)
41 (62.1)
16 (59.3)
7 (63.6)
18 (64.3)
Age 1–9 y, n (%)
47 (71.2)
21 (77.8)
8 (72.7)
18 (64.3)
S anda d isk, n (%)
40 (60.6)
18 (66.7)
6 (54.5)
16 (57.1)
Median PSI, days (IQR)
15 (20.5)
21 (46)
7 (8.5)
14.8 (22.5)
Median PTI, days (IQR)
7.8 (12)
7.5 (21)
3.5 (3.5)
9.3 (8)
Remission, n (%)
34 (51.5)
18 (66.7)
7 (63.6)
9 (32.1)
Relapse, n (%)
4 (6.1)
3 (11.1)
0
1 (3.6)
Induc ion ailu e, n (%)
1 (1.5)
0
0
1 (3.6)
T ea men abandonmen , n (%)
8 (12.1)
0
0
8 (28.6)*
Mo ali y, n (%)
19 (28.8)
6 (22.2)
4 (36.4)
9 (32.1)
3-yea OS, %
71.2
77.8
36.4
67.9
6-yea DFS, %
51.5
66.7
54.6
35.7
PSI = p e-diagnos ic symp oma ic in e al; PTI = p e- ea men in e al; OS = o e all su i al; DFS = disease- ee su i al; NOS =
no o he wise speci ied. *T ea men abandonmen signi ican ly highe in NOS g oup (p<0.001).
Six y-six pedia ic pa ien s wi h acu e lymphoblas ic leukemia (ALL) we e analyzed. Mos we e male (62.1%) and be ween one
and nine yea s old (71.2%). B-cell ALL accoun ed o 40.9% o cases, T-cell o 16.7%, and no o he wise speci ied (NOS) o 42.4%.
A majo i y o pa ien s we e classi ied as s anda d isk (60.6%). The median p e-diagnos ic symp oma ic in e al (PSI) was longes
among B-cell ALL a 21 days compa ed wi h se en days o T-cell ALL and 14.8 days o NOS. The median p e- ea men in e al
(PTI) was sho es in T-cell ALL a 3.5 days and longes in NOS a 9.3 days, wi h he o e all ime om symp om onse o ini ia ion
o chemo he apy ha ing a median o 25 days.
T ea men ou comes showed ha 51.5% o pa ien s achie ed emission, wi h he highes a es among hose wi h B-cell ALL
(66.7%) and he lowes among NOS (32.1%). Relapse occu ed in 6.1% o pa ien s, and induc ion ailu e in 1.5%. T ea men
abandonmen was ma kedly highe among NOS cases a 28.6% (p<0.001). Mo ali y eached 28.8% o e all, wi h he highes
p opo ion in T-cell ALL (36.4%). Su i al analysis demons a ed a h ee-yea o e all su i al (OS) o 71.2%, which pla eaued and
emained s able h ough se en yea s. Disease- ee su i al (DFS) imp o ed o e ime, om 16.7% a one yea o 51.5% a six o
se en yea s, wi h B-cell ALL achie ing he mos a o able long- e m DFS a 66.7%.
Al hough diagnos ic and ea men delays we e sho e han hose epo ed in many low- and middle-income coun ies, su i al
ou comes emained below hose achie ed in high-income se ings, whe e ad anced immunopheno yping, gene ic p o iling, and
a ge ed he apies ha e led o cu e a es exceeding 85–90%. The high p opo ion o NOS classi ica ion e lec s diagnos ic
limi a ions and es ic ed access o comp ehensi e low cy ome y, while ea men abandonmen emains a majo ba ie o
imp o ed ou comes. These indings indica e ha ea lie ecogni ion and as e e e al alone a e insu icien o enhance su i al.
B oade access o accu a e isk s a i ica ion, expanded diagnos ic capaci y, s eng hened pa ien na iga ion, and socioeconomic
suppo o educe abandonmen a e essen ial s eps o na ow he su i al gap o pedia ic ALL in esou ce-limi ed se ings.
Time o Diagnosis, Re e al, and he T ea men Ou comes o Pedia ic Pa ien s wi h Acu e Lymphoblas ic Leukemia
in a Te ia y Re e al Cen e in No he n Luzon, Philippines
IJMRA, Volume 08 Issue 10 Oc obe 2025 www.ijm a.in Page 5708
IV. CONCLUSIONS AND RECOMMENDATIONS
Analysis o a coho o 66 pedia ic ALL pa ien s, p edominan ly males, aged 1-9, e ealed ha B-cell ALL pa ien s expe ienced
he longes p e-diagnos ic in e als, while he NOS ALL g oup aced he mos p olonged p e- ea men delays and a signi ican ly
highe a e o ea men abandonmen (50%). Su i al ou comes also a ied by immunopheno ype, wi h B-cell ALL showing he
mos a o able long- e m su i al a es and T-cell ALL demons a ing he poo es . Aside om immunopheno ype, NCI isk
s a i ica ion was a signi ican p edic o o o e all su i al. Fu he mo e, p e-diagnos ic and p e- ea men in e als in his coho
we e ound o be sho e compa ed o hose in o he middle-income coun ies, hese educ ions did no signi ican ly imp o e
clinical ou comes, which emained compa able o hose eco ded in o he low- and middle-income coun ies. Howe e , when
analyzed in ela ion o high-income coun ies, which bene i om eadily accessible immunopheno yping, gene ic es ing, and
a ge ed he apies, he o e all and disease- ee su i al a es in ou s udy we e signi ican ly poo e .
Based on hese indings, u u e esea ch should p io i ize iden i ying he de e minan s unde lying he disp opo iona ely
high a e o ea men abandonmen in he pedia ic ALL coho . A mixed-me hods design is wa an ed o elucida e he socio-
economic, psychological, and logis ical ba ie s aced by amilies in esou ce-limi ed se ings. Na ional-le el in es iga ions a e
needed o quan i y diagnos ic and ea men delays, pa icula ly in high-incidence egions, and o include la ge , mo e
ep esen a i e samples o enhance gene alizabili y. Longi udinal s udies should also assess su i al and quali y-o -li e ou comes
among pa ien s wi h non-adhe ence o delays compa ed o hose comple ing p o ocols. The esul ing e idence will be pi o al in
guiding a ge ed, e idence-based in e en ions and policy e o ms o s eng hen pa ien na iga ion, imp o e ea men
adhe ence, and op imize su i al ou comes.
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