Zehra Fadoo1, Imran Nisar1, Fatimah Yousuf2, Laila Saleem Lakhani2, Shamvil Ashraf3, Uzma Imam4, Junaid Zaheer1, Ahmed Naqvi5, Asim Belgaumi1,6. 1. Department of Pediatrics and Child Health and Department of Oncology, Aga Khan University, Karachi, Pakistan. 2. Medical Student, Aga Khan University Medical College, Pakistan. 3. Children's Cancer Hospital, Karachi, Pakistan. 4. Pediatric Oncology Department, National Institute of Child Health, Karachi, Pakistan. 5. Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Canada. 6. Department of Pediatric Medicine, Division of Hematology Oncology, Sidra Medical and Research Center, Doha, Qatar.
Abstract
BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common cancer of childhood. Some evidence suggests differences in clinical and cytogenetic characteristics of ALL based on geographic and ethnic variations. However, data on ALL characteristics and early outcome of therapy from low/middle-income countries such as Pakistan are scanty. PROCEDURE: A prospective, multi-institutional cohort study in Karachi enrolled 646 newly diagnosed children with ALL over 3 years. Standard forms were used to collect demographic, clinical, and laboratory data at presentation and at the end of induction. RESULTS: Of the total, 66.1% (n = 427) were males. Median age was 6 (mean ± SE 6.87 ± 0.16; range 0.16-18) years. The most common clinical presentation was fever (88.7%). BPC-ALL was diagnosed in 78.5%, while 17.5% had T-ALL; 28.8% had a WBC >50 × 10(9) /L. With 316 patients karyotyped, hypodiploidy and hyperdiploidy were seen in 5.1% and 10.7%, respectively. Of those tested, ETV6-RUNX1 translocation was detected in 13.2%, while BCR-ABL1 translocation and MLL gene rearrangements were seen in 7.3% and 4.6%, respectively. The cumulative loss to follow up before and during induction was 12.8% (n = 83) and 11.5% (n = 74) died before or during this phase. Induction was successfully completed by only 75.6% (n = 489) of the entire cohort and 69.6% (n = 450) achieved remission. CONCLUSION: These patients had ALL with higher risk features than that reported from developed countries. One quarter failed to complete induction chemotherapy. This suboptimal result requires further study and development of innovative interventions, particularly focusing on the causes and solutions for late referral, abandonment, and infections.
BACKGROUND:Acute lymphoblastic leukemia (ALL) is the most common cancer of childhood. Some evidence suggests differences in clinical and cytogenetic characteristics of ALL based on geographic and ethnic variations. However, data on ALL characteristics and early outcome of therapy from low/middle-income countries such as Pakistan are scanty. PROCEDURE: A prospective, multi-institutional cohort study in Karachi enrolled 646 newly diagnosed children with ALL over 3 years. Standard forms were used to collect demographic, clinical, and laboratory data at presentation and at the end of induction. RESULTS: Of the total, 66.1% (n = 427) were males. Median age was 6 (mean ± SE 6.87 ± 0.16; range 0.16-18) years. The most common clinical presentation was fever (88.7%). BPC-ALL was diagnosed in 78.5%, while 17.5% had T-ALL; 28.8% had a WBC >50 × 10(9) /L. With 316 patients karyotyped, hypodiploidy and hyperdiploidy were seen in 5.1% and 10.7%, respectively. Of those tested, ETV6-RUNX1 translocation was detected in 13.2%, while BCR-ABL1 translocation and MLL gene rearrangements were seen in 7.3% and 4.6%, respectively. The cumulative loss to follow up before and during induction was 12.8% (n = 83) and 11.5% (n = 74) died before or during this phase. Induction was successfully completed by only 75.6% (n = 489) of the entire cohort and 69.6% (n = 450) achieved remission. CONCLUSION: These patients had ALL with higher risk features than that reported from developed countries. One quarter failed to complete induction chemotherapy. This suboptimal result requires further study and development of innovative interventions, particularly focusing on the causes and solutions for late referral, abandonment, and infections.
Authors: Jeremy Wang; Nickhill Bhakta; Vanessa Ayer Miller; Mahler Revsine; Mark R Litzow; Elisabeth Paietta; Yuri Fedoriw; Kathryn G Roberts; Zhaohui Gu; Charles G Mullighan; Corbin D Jones; Thomas B Alexander Journal: JCO Precis Oncol Date: 2022-04
Authors: José Carlos Jaime-Pérez; Gisela García-Arellano; José Luis Herrera-Garza; Luis Javier Marfil-Rivera; David Gómez-Almaguer Journal: Hematol Transfus Cell Ther Date: 2018-07-27