Prognostic Variables and Survival in Pediatric Acute Lymphoblastic Leukemias: Cancer Institute Experience

Shanta, V.; Maitreyan, V.; Tenali, Sagar; Gajalakshmi, C. K.; Rajalekshmy, K. R.

doi:10.3109/08880019609030819

Cited by 31 publications

(19 citation statements)

References 17 publications

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“…This is consistent with the national and international data where younger age has been associated with poor outcomes. 17,18 In the present study, no statistically significant difference in outcome was observed between those with myeloid coexpression and those without myeloid co-expression.…”

Section: Factors Associated With Poor Outcomecontrasting

confidence: 66%

A study on clinical, immunophenotypic pattern in pediatric acute leukemias in a teaching hospital

Pandian

Sankarasubramaian

2018

Int J Contemp Pediatr

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INTRODUCTIONAcute leukemias are one of the most common malignancies in children aged <15 years, accounting for nearly 30%. Though several risk factors have been proposed, a specific etiology has not been determined till date. Fortunately, it is one of the curable malignancies in children and hence early diagnosis is essential.Studies from India have reported variable outcomes, with few specialized centers showing a favourable outcome in more than 70%.1 Not all children have access to the regional Cancer Institutes of India. Children managed at other centers must also receive a minimum standard of care. Multiple poor prognostic factors are described in ALL such as age <1 year or >10 years, male sex, very high leukocyte count, mature B-cell type and T-cell type of ALL, chromosomal abnormalities {ex: t (9;22) or t (4;11)}, which when present have a high chance of relapse and mortality. Whether the risk factors in our population are similar or any other unique risk factor operates in our patients, has to be confirmed.Flowcytometry has now become a standard tool for diagnosing and monitoring acute as well as chronic leukemia. Immunophenotyping by flow cytometry enables accurate diagnosis and treatment on the basis of which further treatment is planned. Immunophenotyping ABSTRACT 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.

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Section: Factors Associated With Poor Outcomecontrasting

confidence: 66%

A study on clinical, immunophenotypic pattern in pediatric acute leukemias in a teaching hospital

Pandian

Sankarasubramaian

2018

Int J Contemp Pediatr

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“…The cure rates have improved from virtually zero, prior to the advent of modern chemotherapy and radiotherapy (in 1950s), to the current overall event-free survival rates of approximately 80%. [2][3][4] The cure rates of children with ALL in India are improving, akin to the western world. However, reports from several institutions in India suggest that outcome is inferior to that achieved in the west.…”

Section: Introductionmentioning

confidence: 99%

“…An array of clinical and biological features have been identified as prognostically significant in childhood ALL, including age, presenting leukocyte count, Immunophenotypic, chromosomal abnormalities, the presence of overt central nervous system leukemia and the rapidity with which the patients demonstrate a response to initial induction chemotherapy. [4][5][6] Risk factors are utilized for stratification of therapy. [6][7][8] More intensive therapies are administered to patients considered to have the highest risk of relapse.…”

Section: Introductionmentioning

confidence: 99%

“…Although there are multiple studies performed across the world, there is paucity of literature available on the risk factors, pattern of relapsed disease and outcome of children with ALL in India. [4][5][6] With this background we conducted a study to assess the various prognostic factors and the impact they have on the outcome in children treated for ALL in our institute focusing on Immunophenotypic and Cytogenetics In the 186 patients that opted for treatment the status of blasts in peripheral blood at day 8 and bone marrow status at day 33 was assessed to determine the response to therapy. The outcome in terms of survivor and nonsurvivor was determined.…”

Section: Introductionmentioning

confidence: 99%

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Acute lymphoblastic leukemia, the Indian scenario

Guru¹,

Muzamil²,

Bashir³

et al. 2018

MOJCSR

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“…3 A marginally higher incidence of OTD and increased incidence of 'high-risk' (71.4%) in these patients, could be partly explained by an overall increased incidence of high-risk disease in an Indian setting. [8][9][10][11][12][13][14] Several Indian investigators have documented that over 65 to 70% of the cases of ALL could be categorized as 'high-risk', based on male gender, bulk disease, age, WCC at presentation and mediastinal/CNS disease. [8][9][10][11][12][13][14] In contrast, high-risk disease in encountered much less frequently is data stemming from developed nations.…”

Section: Discussionmentioning

confidence: 99%

Overt testicular disease at diagnosis in childhood acute lymphoblastic leukemia: prognostic significance and role of testicular irradiation

et al. 2010

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Objective. To analyze the prognostic impact of overt testicular disease (OTD) at diagnosis and role of testicular irradiation in the same.Methods. Data of 579 boys treated at our center over 16 years was reviewed.Results. Fourteen (2.4%) males had OTD. 10 (71.4%) of these had high-risk disease. Patients with OTD, had a significantly higher incidence of mediastinal-adenopathy (p=0.001), hyperleucocytosis (p=0.004) and CNS disease at presentation (p<0.0001) compared to patients in continuous complete remission (CCR). 4 of the 11 patients with OTD, who opted for therapy, had relapse; 2 are in CCR. Although, survival in patients with OTD was inferior (p=0.183) compared to patients without OTD, it was not an independent prognostic factor (p=0.47). In the entire study cohort, symptom-diagnosis interval (p=0.006), white cell (p=0.001) and platelet count (p=0.001) at presentation were significantly associated with survival (Cox multivariate regression analysis). Conclusions. OTD was not an independent prognostic factor, despite association with high-risk features. Survival outcome was inferior. The observations indicate the need of revaluation of the present protocol with incorporation of intermediate dose and subsequently high-dose methotrexate (after assessment for toxicity and tolerance), risk-stratified therapy and plausibly omission of testicular irradiation. [Indian J Pediatr 2010; 77 (7) : 779-783]

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Prognostic Variables and Survival in Pediatric Acute Lymphoblastic Leukemias: Cancer Institute Experience

Cited by 31 publications

References 17 publications

A study on clinical, immunophenotypic pattern in pediatric acute leukemias in a teaching hospital

A study on clinical, immunophenotypic pattern in pediatric acute leukemias in a teaching hospital

Acute lymphoblastic leukemia, the Indian scenario

Overt testicular disease at diagnosis in childhood acute lymphoblastic leukemia: prognostic significance and role of testicular irradiation

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