HEMATOLOGICAL PREDICTORS OF OUTCOME IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA IN DUHOK
Abstract
https://doi.org/10.31386/dmj.2022.16.2.3
Background: While numerous studies have addressed the outcome of childhood acute lymphoblastic leukemia (ALL) in western developed countries, there is a scarcity of data in developing countries. This study explores the hematological predictors of outcomes in childhood acute lymphoblastic leukemia in Duhok city- Kurdistan Iraq.
Method: the current study represents a cross-sectional study, conducted in Hivi Pediatric hospital and Zheen oncology center in Duhok, Iraq, and 116 patients were enrolled. The main features of childhood ALL, hematological predictors, type of therapy, and risk factors were analyzed to assess their effect on treatment outcome and survival rate.
Results: Median age of the study cohort was 5 years and the male-to-female ratio of 1.4:1. 87.9% of the cases were B-ALL while 12.1 were T-cell. Blood counts revealed a mean WBC count of 54.34 x 109/L, mean hemoglobin of 7.913 g/dl, and mean platelet count of 68.96 x 109/L. Complete remission (CR) rate was 92.2%, the overall 5-year survival (OS) was 76.7%, and relapse-free 5-year survival (RFS) was 73.3%. Patients with B-cell ALL had significantly higher OS compared to patients with T-cell (p value=0.01). Patients stratified into high-risk groups had significantly lower RFS and OS compared to the intermediate and standard risk groups (p value=0.04, 0.008 respectively). Patients aged >10 years had significantly lower RFS (p value=0.001). Other factors such age<1 year, PLT count, Hb count, and gender did not predict poor outcome
Conclusion: Immunophenotype, age>10 years and risk stratification are important predictors of outcome in childhood ALL in our study, most notably, the patients’ survival rates were inferior to similar reports from western developed countries, The key areas for future work should include wider implementation of MRD and cytogenetic analysis in risk stratification to improve the outcome of childhood ALL.
Downloads
References
2. Vecchi, V., Aricò, M., Basso, G., Ceci, A., Madon, E., Mandelli, F. et al. (1993). Risk-directed therapy for childhood acute lymphoblastic leukemia. Results of the Associazione Italiana Ematologia Oncologia Pediatrica '82 studies. Cancer, 72(8), 2517–2524.Doi:10.1002/10970142(19931015)72:8<2517::aidcncr2820720834>3.0.co;21
3. Teachey, D., & Hunger, S., (2013). Predicting relapse risk in childhood acute lymphoblastic leukaemia. British Journal of Haematology, 162(5), 606–620. https://doi.org/10.1111/bjh.12442
4. Howard, S. (2004). Establishment of a Pediatric Oncology Program and Outcomes of Childhood Acute Lymphoblastic Leukemia in a Resource-Poor Area. JAMA, 291(20), 2471. doi: 10.1001/jama.291.20.2471
5. Ribeiro, R., Steliarova-Foucher, E., Magrath, I., Lemerle, J., Eden, T., & Forget, C. et al. (2008). Baseline status of paediatric oncology care in ten low-income or mid-income countries receiving My Child Matters support: a descriptive study. The Lancet Oncology, 9(8), 721-729. doi: 10.1016/s1470-2045(08)70194-3
6. Wali, R., Anjum, S., Amjad, A., Shaheen, N., & Khan, S. (2021). Frequency of Infectious Mortality at the End of Induction Chemotherapy in Acute Lymphoblastic Leukemia and Lymphoma Patients: Findings from a Tertiary Care Cancer Center. Cureus. doi: 10.7759/cureus.13208
7. Nick G. (2013). United Kingdom National Randomized Trial for Children and Young Adults with Acute Lymphoblastic Leukaemia and Lymphoma. University of Birmingham. United Kingdom. 111 – 167:03.
8. Van Dongen, J., Lhermitte, L., Böttcher, S., Almeida, J., van der Velden, V., FloresMontero,J et al. (2012). EuroFlow antibody panels for standardized n-dimensional flow cytometric immunophenotyping of normal, reactive and malignant leukocytes. Leukemia, 26(9), 1908–1975. https://doi.org/10.1038/leu.2012.120
9. Jalal, S. D., Al-Allawi, N., & Al Doski, A. (2017). Immunophenotypic aberrancies in acute lymphoblastic leukemia from 282 Iraqi patients. International journal of laboratory hematology, 39(6), 625–632. https://doi.org/10.1111/ijlh.12716
10. Lee, J., & Cho, B. (2017). Prognostic factors and treatment of pediatric acute lymphoblastic leukemia. Korean Journal Of Pediatrics, 60(5), 129. doi: 10.3345/kjp.2017.60.5.129
11. Cooper, S., & Brown, P. (2015). Treatment of Pediatric Acute Lymphoblastic Leukemia. Pediatric Clinics of North America, 62(1), 61-73. doi: 10.1016/j.pcl.2014.09.006
12. Halalsheh, H., Abuirmeileh, N., Rihani, R., Bazzeh, F., Zaru, L., & Madanat, F. (2011). Outcome of childhood acute lymphoblastic leukemia in Jordan. Pediatric Blood &Amp; Cancer, 57(3), 385-391. doi: 10.1002/pbc.23065
13. Howlader, N., Noone, AM., Krapcho, M., et al. (2013). SEER Cancer Statistics Review, 1975-2010. National Cancer Institute. Bethesda, MD.
14. Reedijk, A., Coebergh, J., de Groot-Kruseman, H., van der Sluis, I., Kremer, L., Karim-Kos, H., & Pieters, R. (2020). Progress against childhood and adolescent acute lymphoblastic leukaemia in the Netherlands, 1990–2015. Leukemia, 35(4), 1001-1011. doi: 10.1038/s41375-020-01024-0
15. Rubnitz, J., Lensing, S., Zhou, Y., Sandlund, J., Razzouk, B., Ribeiro, R., & Pui, C. (2004). Death during induction therapy and first remission of acute leukemia in childhood. Cancer, 101(7), 1677-1684. doi: 10.1002/cncr.20532
16. Al-Hadad, S., Al-Jadiry, M., Ghali, H., Al-Badri, S., Al-Saeed, R., & Al-Darraji, A. et al. (2021). Treatment of childhood acute lymphoblastic leukemia in Iraq: a 17-year experience from a single center. Leukemia &Amp; Lymphoma, 62(14), 3430-3439. doi: 10.1080/10428194.2021.1961237.
17. Mao, R., Hu, S., Zhang, Y., Du, F., Zhang, Y., Liu, Y., & Zhang, T. (2020). Prognostic Nomogram for Childhood Acute Lymphoblastic Leukemia: A Comprehensive Analysis of 673 Patients. Frontiers In Oncology, 10. doi: 10.3389/fonc.2020.01673
18. Reaman, G. H., Sposto, R., Sensel, M. G., et al. (1999). Treatment outcome and prognostic factors for infants with acute lymphoblastic leukemia treated on two consecutive trials of the Children's Cancer Group. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 17(2), 445–455. https://doi.org/10.1200/JCO.1999.17.2.445
19. Schultz, K., Pullen, D., Sather, H., Shuster, J., Devidas, M., & Borowitz, M. et al. (2006). Risk- and response-based classification of childhood B-precursor acute lymphoblastic leukemia: a combined analysis of prognostic markers from the Pediatric Oncology Group (POG) and Children's Cancer Group (CCG). Blood, 109(3), 926-935. doi: 10.1182/blood-2006-01-024729
20. Winter, S., Dunsmore, K., Devidas, M., Wood, B., Esiashvili, N., & Chen, Z. et al. (2018). Improved Survival for Children and Young Adults With T-Lineage Acute Lymphoblastic Leukemia: Results From the Children’s Oncology Group AALL0434 Methotrexate Randomization. Journal Of Clinical Oncology, 36(29), 2926-2934. doi: 10.1200/jco.2018.77.7250.
21. Conter, V., Bartram, C., Valsecchi, M., Schrauder, A., Panzer-Grümayer, R., & Möricke, A. et al. (2010). Molecular response to treatment redefines all prognostic factors in children and adolescents with B-cell precursor acute lymphoblastic leukemia: results in 3184 patients of the AIEOP-BFM ALL 2000 study. Blood, 115(16), 3206-3214. doi: 10.1182/blood-2009-10-248146
22. Kato, M., & Manabe, A. (2018). Treatment and biology of pediatric acute lymphoblastic leukemia. Pediatrics International, 60(1), 4-12. doi: 10.1111/ped.13457
23. Teachey, D., & Pui, C. (2019). Comparative features and outcomes between paediatric T-cell and B-cell acute lymphoblastic leukaemia. The Lancet Oncology, 20(3), e142-e154. doi: 10.1016/s1470-2045(19)30031-2
24. Moorman, A., Ensor, H., Richards, S., Chilton, L., Schwab, C., & Kinsey, S. et al. (2010). Prognostic effect of chromosomal abnormalities in childhood B-cell precursor acute lymphoblastic leukaemia: results from the UK Medical Research Council ALL97/99 randomised trial. The Lancet Oncology, 11(5), 429-438. doi: 10.1016/s1470-2045(10)70066-8
25. Kim, I. (2020). Minimal residual disease in acute lymphoblastic leukemia: technical aspects and implications for clinical interpretation. BLOOD RESEARCH, 55(S1), S19-S26. doi: 10.5045/br.2020.s004
26. Pui, C., Yang, J., Bhakta, N., & Rodriguez-Galindo, C. (2018). Global efforts toward the cure of childhood acute lymphoblastic leukaemia. The Lancet Child &Amp; Adolescent Health, 2(6), 440-454. doi: 10.1016/s2352-4642(18)30066-x
27. dear zana this is the reference it’s a PDF and I didn’t know how to make it a reference please help also should be number 7
