A study on clinical, immunophenotypic pattern in pediatric acute leukemias in a teaching hospital
DOI:
https://doi.org/10.18203/2349-3291.ijcp20182064Keywords:
Acute lymphoblastic leukemia, Flowcytometry, Immunophenotype, Myeloid antigenAbstract
Background: Acute leukemia contributes to nearly one third of the pediatric malignancies. For effective management of a curable malignancy, the epidemiology of childhood leukemias and audit of previously treated patients would be required. The objective was to study the clinical and immunophenotypic pattern of acute leukemia in children <12 years of age admitted in a tertiary centre.
Methods: Prospective study done on 31 children, diagnosed as leukemia and treated over a period of 3 years in GRH, Madurai. Detailed history analysis, clinical examination, lab investigations including flowcytometry were done.
Results: ALL was the most common acute leukemia in children (90.3%). 85.7% were identified as B-cell and 14.3% as T-cell. Of the B-ALL, 87.5% was pre-B, 8.3% pro-B and 4.2% mature B ALL. Myeloid antigen co-expression was seen in 35.7%. Fever was the most common symptom (87%) and hepatosplenomegaly was the most common sign (>90%). Poor outcome was noted in 42.3%. T-cell appeared to have worse prognosis than B-cell but did not retain independent prognostic significance in univariate analysis.
Conclusions: B-ALL was more common than T-ALL. Extra medullary organ involvement indicates increased tumor burden and poor outcome. None of the clinical or laboratory parameters appeared to predict poor outcomes in our study and this may be due to small sample size. This study provides an insight into the data regarding the epidemiology, clinicopathologic feature and outcome of acute leukemia in a center with low resource settings.
References
Kulkarni KP, Arora RS, Marwaha RK. Survival outcome of childhood acute lymphoblastic leukemia in India: a resource-limited perspective of more than 40 years. J Pediatri Hematol/Oncol. 2011;33:475-9.
Kulkarni KP, Marwaha RK, Trehan A, Bansal D. Survival outcome in childhood ALL: experience from a tertiary care centre in North India. Pediatr Blood and Cancer. 2009;53:168-73.
Singh BM, Singh R, War E, Hmar L. Leukemia in children ; Paper presented at Bangalore Pedicon 2002.
Manisha B, Vinod K, Sameer B. childhood ALL indian experience. (AIIMS) Indian J Medi Paediatr oncol.2004;25:234-6
Advani S, Pai S, Venzon D, Adde M, Kurkure Pk, Nair CN, et al. Acute lymphoblastic leukemia in India. An analysis of prognostic factors using a single treatment regimen. Ann oncol. 1999;10: 167-76.
Swaminathan R, Rama R, Shanta V. Childhood cancers in Chennai, India, 1990-2001: incidence and survival. International journal of cancer. J Int du Cancer. 2008;122:2607-11.
Pui CH. Acute Lymphoblastic Leukemia. The Pediatric Clinics of North America: Pediatr Oncol. 1997;44:831-40
Neimeyer CM, Sallan SE., Acute lymphobalstic Leukemia. In Nathan and Oskis Hematology of infancy and Childhood, 5th ed, WB Saunders. 1998;1245-69.
Yasmeen N, Ashraf S. Childhood acute lymphoblastic leukaemia; epidemiology and clinicopathological features. JPMA J Pak Medi Assoc. 2009;59:150-3.
Kulkarni KP, Marwaha RK. Significant male preponderance in childhood acute lymphoblastic leukemia in India and regional variation: tertiary care center experience, systematic review, and evaluation of population-based data. Pediatr Hematol Oncol. 2013;30:557-67.
Rogalsky RJ, Black GB, Reed MH. Orthopaedic manifestations of leukemia in children. J Bone Joint Surg American Vol. 1986;68:494-501.
Hann IM, Gupta S, Palmer MK, Morris-Jones PH. The prognostic significance of radiological and symptomatic bone involvement in childhood acute lymphoblastic leukaemia. Medi Pediatri Oncology. 1979;6:51-5.
Jonsson OG, Sartain P, Ducore JM, Buchanan GR. Bone pain as an initial symptom of childhood acute lymphoblastic leukemia: association with nearly normal hematologic indexes. J Pediatri. 1990;117:233-7.
Saha A, Dandekar S, Milla S, Roman E, Bhatla T. Bilateral parotid gland enlargement and palpable nephromegaly in infant acute lymphoblastic leukemia: case report and review of the literature. J Pediatri Hematol/Oncol. 2014;36:246-8.
Biswas S, Chakrabarti S, Chakraborty J, Paul PC, Konar A, Das S. Childhood acute leukemia in West Bengal, India with an emphasis on uncommon clinical features. Asian Pacific journal of cancer prevention : APJCP. 2009;10:903-6.
Mantan M, Singhal KK, Sethi GR. Acute lymphoblastic leukemia: an unusual cause of nephromegaly in infancy. Indian J Pediatri. 2010;77:583.
Shanta V, Maitreyan V, Sagar TG, Gajalakshmi CK, Rajalekshmy KR. Prognostic variables and survival in pediatric acute lymphoblastic leukemias: cancer institute experience. Pediatric Hematol Oncol. 1996;13:205-16.
Khalid S, Moiz B, Adil SN, Khurshid M. Retrospective review of pediatric patients with acute lymphoblastic leukemia: a single center experience. Indian J Pathol Microbiol. 2010;53(4):704-10.
Iwamoto S, Ohta H, Kiyokawa N, Fujimoto J, Tsurusawa M, Yamada T. Flow Cytometric Analysis of de novo acute lymphoblastic leukemia in Childhood. Report from Japanese Pediatric Lymphoma/Leukemia study group. Int J Hematol. 2011;94:185-92.
