Surveillance and expected outcome of acute lymphoblastic leukemia in children and adolescents: An experience from Eastern India

Abstract

Objective:Research in Eastern India especially among children and adolescents for acute lymphoblastic leukemia (ALL) have not been well documented until recently when it was conducted at a cancer institute of tertiary care with primary objectives of examining and correlating different cell surface markers involved with respect to disease surveillance thereby highlighting it as a strong prognostic marker for future diagnosis and treatment.Materials and Methods:A total of 500 consecutively selected ALL patients were diagnosed and treated according to National Cancer Institute protocol (MCP 841) for a period of 24-88 months during this hospital-based study.Results:Of the total, 50.4% had a higher incidence of T-ALL and 47.6% had pro-B, B-cell precursor ALL. Disease free survival and event free survival were remarkably higher in B-ALL adolescent patients as compared to T-ALL, who had significantly lower overall survival ratio. Prevalence of T-ALL was also observed in relapse cases for adolescent patients.Conclusions:We conclude that there is an increased prevalence of T-ALL among adolescents in Eastern India. Immunophenotypic analysis might help in proper evaluation and prediction of treatment outcomes with an increased thrust on studying age-specific incident rates enabling well planned future treatments for improved and better outcome.

Spectrum of acute leukemias diagnosed on flow cytometry: Analysis from tertiary care centre from North India

“…Similar study was observed in the West, the predominant immunophenotype observed in ALL was B-ALL, accounting for 60-80% of total cases, whereas T-ALL comprised only of 15-20% [9]. In one study from eastern India, both T-ALL (50.4%) and B-ALL (49.6%) incidence was almost equal in distribution [10].…”

CD34 Positive Pediatric T Lymphoblastic Leukemia: A Tertiary Care Centre Experience

“…Furthermore, there is paucity of data addressing clinical features, prognostic parameters and outcome of T ALL in developing countries like India, where this ALL subtype is more frequently observed than in the developed nations (16,17) . Disease free survival and event free survival were higher in B ALL in adolescent patients as compared to T ALL who had significantly low survival rates (18) . Hence even though the present study showed the predominant type to be B ALL (85.6%) we concentrated on T ALL which constituted only 14.4%.CD34 is a human stage specific haematopoetic differentiation antigen and is expressed in early undifferentiated haematopoetic stem cells,both in lymphoid and myeloid lineage.In leukemic cells it remains to be expressed over several stages of lymphoid and myeloid maturation.The incidence of CD34 positvity is low in T ALL worldwide (7)(8)(9)(10)(11) (table.2) which is in contrast to the present study.…”

Analysis of outcomes and prognostic factors of acute lymphoblastic leukemia patients treated by MCP841 protocol: A regional cancer center experience

“…[17] Another recent Eastern Indian study reported 50.4% incidence of T-cell immunophenotype. [8] Western studies have reported <10% incidence. [16] These data clearly establish the difference in the biologies of ALL in India from the Western world.…”

“…This was in accordance with both Indian and Western studies. [8161730] CNS relapse was observed in 2.4% of the patients who achieved remission. In an Indian study by Raje et al ., this figure was 1.76%.…”

“…[1234] However, reports from various institutions in India suggest that the outcome is inferior to that achieved in the developed nations due to poor management of infections, leading to toxic deaths and also increased incidence of relapse. [5678910] The patient population of India differs markedly from the Western population with respect to the prevalence of illiteracy, poverty, malnutrition, and chronic infectious diseases. Although multiple studies have been performed across the world; there is a deficiency of data available on the prognostic factors, response to treatment, and research on the biology of ALL from the Northwest Indian perspective.…”