Profile and outcome of children with Acute Lymphoblastic Leukemia: A study from a tertiary care centre from North India

Abstract

Background: Acute lymphoblastic leukemia (ALL) is the most common type of childhood malignancy. The study of prognostic indicators that can predict the survival of these patients is necessary to identify the factors associated with the rate of relapse in any set of patients. Therefore, the present study aimed to evaluate the clinical characteristics, prognostic factors and the treatment outcome measurements of pediatric ALL patients treated in a tertiary care center in North India. Material and methods: This hospital-based observational study was conducted on 180 pediatric patients aged between 1 year to 18 years who had visited the Department of Medical Oncology at Sher-I-Kashmir institute of Medical science, Srinagar Jammu and Kashmir between the January 2015 to December 2019 were included. Result: A total of 180 children with ALL were included in this study. 57.8% were males and 42.2% were females with a mean age of 9.2 (±3.5) years and median of 8 years. Majority of patients (68%) were below 10 years. 57.8% were males and 42.2% were females. The male: female ratio was 1.3:1. Central nervous system disease at diagnosis was seen in 7.8% patients. The mean and the median TLC were 56000/μl and 12000/μl respectively. The TLC was more than 20000/μl in 63.3% patients. The immune phenotyping analysis revealed Pre B ALL in 77.8%, B cell in 9.4% and T cell ALL in 12.8% patients. Conventional cytogenetic revealed normal cytogenetics in 87.6%, hyperdiploidy in 8.5% and hypodiploidy in 3.9%. FISH for TEL AML, MLL, BCR-ABL gene rearrangement analysis was positive in 23.3%, 4.4%, 11.1% patients respectively. No statistical significant association was observed between the age of the patients, gender, TLC count, BCR-ABL or TEL-AML assays. The presence of CNS disease and survival of the patients showed a significant statistical correlation (P=0.038). The MLL-gene rearrangement analysis had significant statistical correlation (p-value=00). The overall survival rate was 78%. The EFS rate was 70.5%. There were a total of 45 relapses, among the relapse cases, 55.5% had bone marrow relapse, 11.1% had CNS relapse, 26.7% had combined CNS and bone marrow, and 6.7% had a testicular relapse. Conclusion: The study results show that our results are comparable to some other centres in India. Identification of prognostic risk factors and risk stratification helps to achieve a higher survival rate childhood ALL patients.