Analisis Faktor yang Memengaruhi Kesintasan Leukemia Limfoblastik Akut Anak di Rumah Sakit Adam Malik Medan

Abstract

Background: Acute lymphoblastic leukemia (ALL) is the most common type of childhood blood cancer in Indonesia, accounting for over 33% of all leukemia cases. Despite ongoing updates to treatment protocols, the survival rate of children with ALL in Indonesia remains low at around 30-60%, significantly lower than in high-income countries where it approaches 90%. Several prognostic factors—including age, sex, nutritional status, hemoglobin levels, initial white blood cell (WBC) count, and early treatment response—are known to influence survival. However, local studies examining survival and prognostic factors in pediatric ALL remain limited, particularly at Adam Malik Hospital, a major referral center in North Sumatra. Objective: To determine the survival rate and prognostic factors in children with ALL at Adam Malik Hospital. Method: A retrospective cohort study was conducted using secondary data from medical records and the leukemia patient registry at Adam Malik Hospital. The study included pediatric ALL patients diagnosed between 2021 and 2022 and treated according to the 2018 Indonesian ALL Protocol. Treatment outcomes were assessed after a two-year follow-up period. Result: The two-year survival rate of children with ALL at H. Adam Malik Hospital was 47.2%. Log-rank analysis showed significant differences in survival based on age (p = 0.016), hemoglobin level (p = 0.034), initial WBC count (p < 0.001), and risk stratification (p = 0.002). Multivariate analysis using Cox proportional hazards regression revealed that only the initial WBC count had a significant impact on mortality risk (p = 0.031; HR 2.046; 95% CI: 1.069–3.918). Conclusion: The survival rate of pediatric ALL patients at H. Adam Malik Hospital is relatively low. Initial white blood cell count at diagnosis significantly influences outcomes in children with ALL.