Annals of PIMS-Editorial Board

Objective: To look into the known prognostic factors of Acute Lymphoblastic Leukeamia in Children
Materials and Methods: A retrospective study on children with a diagnosis of acute lymphoblastic leukeamia was conducted at Oncology department, Children Hospital, Pakistan Institute of Medical Sciences Islamabad. All the Leukaemic patients registered form January 2007- August 2009 were included in this study. Their detailed clinical history specially age, sex, lymphadenopathy, hepatosplenomegaly, testicular enlargement, mediastinal masses as well as the CNS disease was thoroughly interrogated. All pre-induction investigations including Haemoglobin level, white blood cell Count, Platelet count, peripheral blast count and bone marrow blast count were noted and compared with the post induction values.
Results: Among the children having acute lymphoblastic leukeamia the mean age of presentation was 5 years four month with male to female ratio of 2:1. 58% of patients had hepatomegaly and 60 % had splenomegaly. Pre-induction bone marrow blast count in majority of the patients was >80%. Pre-induction mean WBC count was 26.3 x 109, mean Hb was 7.1 g/dl, and mean platelet count was 77.1 x 109. The post-induction WBC count was 3.5 x 109, mean Hb was 8.9 g/dl and platelet count was 174.2 x 109. Regarding the FAB classification, 60% of the cases were of ALL-L1; these patients showed a good response in 86% and were categorized prognostically as M1 [on post- induction blast count basis].
Conclusions: Majority of children with ALL had ALL-L1 morphology, having pre-induction bone marrow blast cell count of >80%, which reduced to <1% with multi-agent induction therapy.
Key words: Acute Lymphoblastic Leukeamia, Prognostic Factors, Hepatosplenomegaly, Peripheral blast count, Prednisolone response

Introduction

Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children, representing nearly one third of all pediatric cancers. The annual incidence rate for acute lymphoblastic leukemia is 30.9 cases per million population. The peak incidence occurs in children aged 2-5 years.¹
This disease has been recognized as clinically and morphologically heterogeneous. Morphologically it has been classified according to the FAB (French, American and British) criteria into three subtypes, L1, L2 and L3.^2-4 This system of classification, which is still valid, had been proven to be clinically reproducible.^1-3
The current study is planned to verify the incidence of ALL subtypes and their relation to age, sex and clinical and haematological presentations along with response to therapy in our setup. ALL in infancy has been associated with unfavorable features such as hyperleukocytosis, hepatosplenomegaly, and central nervous system (CNS) disease.^4,5 Correlation between various clinical and laboratory characteristics and outcomes has been studied. These factors are interrelated, making it difficult to identify independent prognostic factors. Higher white blood cell (WBC) count correlates with worse outcomes, but the WBC categories for comparison have varied in the different reports.^6-8 In the last 30 years, the cure rate in Childhood acute lymphoblastic leukemia (ALL) has increased to 80%.⁹ Remission induction therapy generally consists of a combination of three or four drugs (vincristine, prednisone, and L-asparaginase, with or without an anthracycline) with CNS prophylaxis, based on the risk classification at diagnosis. This multi-agent therapy achieves complete remission (CR) in the vast majority (> 95%) of children with ALL.^10-14