The Impact of Routing on a Speedy Diagnosis of Acute Leukemia in Children: Results of a Regional Study

Abstract

BACKGROUND. Acute leukemia (AL) is the most common pediatric malignancy with an incidence of 55–62 cases per million population under 18 years. The nonspecificity of primary symptoms creates a challenge for early diagnosis, especially in the regions with a population of up to 100,000, where pediatric AL is diagnosed once every 2–5 years. Furthermore, the outpatient physicians are seldom alert to cancer symptoms.

AIM. To assess the impact of routing on a speedy AL diagnosis in children as shown in the Tver Region.

MATERIALS & METHODS. The trial enrolled 35 patients with diverse AL variants hospitalized in the hematology department of the Pediatric Regional Clinical Hospital (PRCH) during 2018 to 2023. There were 30 (86 %) children with acute lymphoblastic leukemia (ALL), 3 (9 %) children with acute myeloid leukemia (AML), and 2 (5 %) children with acute leukemia of unspecified cell type (ALUCT). The age of children was 1.1–17 years, the mean age was 5.1 years. There were 18 girls and 17 boys. By the time of initial diagnosis, thrombocytopenia and anemia were identified in 76 % and 78 % patients, respectively. Leukocytosis > 20 × 10⁹/L was detected in 58 % patients, and leukopenia < 3.5 × 10⁹/L was observed in 15 %. Blast cells 2–95 % were found in the peripheral blood in 97 % of cases. On the whole, 16 (46 %) and 19 (54 %) AL patients were identified in the city of Tver (group 1) and in the Tver Region (group 2), respectively.

RESULTS. In groups 1 and 2, ALL was diagnosed in 14 (88 %) and 16 (84 %) children, AML was diagnosed in 1 (6 %) and 2 (11 %), and ALUCT in 1 (6 %) and 1 (5 %) children, respectively. The overall diagnosis delay (n = 35) was < 2 weeks in 21 (60 %) children, 2–4 weeks in 7 (20 %), > 4–≤ 8 weeks in 4 (11 %), and > 8 weeks in 3 (9 %) children. In the city of Tver and in the Tver Region, the diagnosis delay was < 2 weeks in 7 (44 %) vs. 13 (68 %) patients, 2–4 weeks in 6 (38 %) vs. 3 (17 %), > 4–≤ 8 weeks in 1 (6 %) vs. 1 (5 %), and > 8 weeks in 2 (12 %) vs. 2 (10 %) patients, respectively. The time of diagnosis could not be reliably associated with the distance from patient’s residence to a third-level[1] pediatric specialized medical care institution (PRCH). With the distance of < 50 km, the diagnosis was delayed < 2, 2–4, > 4–≤ 8, and > 8 weeks in 36 %, 36 %, 21 %, and 7 % of patients, respectively. The same delayed diagnosis in patients with > 100 km residential distance to hospital was observed in 30 %, 30 %, 20 %, and 20 % children, respectively. With the distance of 50–100 km, AL was diagnosed within 2–4 weeks in all 35 children enrolled in this trial.

CONCLUSION. The residential distance to the PRCH of Tver had no effect on the time of AL diagnosis in children. For a speedier diagnosis, daily conferences at the medical institutions of the Tver Region as well as timely hospitalization of children with suspected hematologic malignancies at the appropriate department of the PRCH of Tver appeared to be indispensable.

[1] Medical institutions are stratified by level of care (staging) in accordance with the Decree No. 358 of the Ministry of Health of the Russian Federation dated June 8, 2016, On the approval of methodological guidelines for the development of the state and municipal healthcare network based on the Federal Act No. 323-ФЗ dated November 21, 2011 (revised 25.12.2023), On fundamental healthcare principles in the Russian Federation, Article 37, Cl. 5.1.