Clinicolaboratory Characteristics and Outcome of Pediatric Acute Lymphoblastic Leukemia in a Resource-Limited Setting: A Study from South Egypt

Abstract

Background: Remarkable progress has been made in the treatment of pediatric acute lymphoblastic leukemia (ALL), with survival rates reaching > 80% in high-income countries. In Egypt, the outcome of treatment of ALL has been less favorable. Aim: To evaluate the clinicolaboratory characteristics in patients admitted at Sohag Cancer Center and to assess the outcome and the prognostic factors affecting it. Methods: This retrospective study included 79 pediatric ALL patients, from January 2010 to December 2014, who were treated according to modified Total therapy study XIIIB high-risk ALL of St. Jude Children's Research Hospital (SJCRH). Results: 52% were males with a median age of 6 years. 58.2% were stratified as HR, 69.6% had precursor B-ALL, 39.2% presented with total leucocytic count (TLC) (≥ 50x109/L), and 11.3% had CNS leukemia. Complete remission (CR) was achieved in 87.3%. Regarding treatment outcome, induction failure was reported in 5.1%, relapse in 24.1%, deaths in CR in 7.2%, and continuous complete remission in 59.5%. The median follow-up was 42 months, 4 years OS, EFS, and DFS were 64.1 ± 5.6, 57 ± 5.7, and 63.3 ± 5.8% respectively. TLC and bone marrow aspirate postinduction were the only significant prognostic factors affecting EFS. Conclusions: The modified TXIIIB of SJCRH was effective in improving ALL outcomes in our center, however, survival rates were much lower than internationally reported results with only initial TLC and response postinduction having a significant effect on EFS and DFS.

Association of GATA3 Rs3824662 Gene Polymorphism with Response to Induction Therapy in Acute Lymphoblastic Leukemia

“…In the pediatric group of our study, the median age was 5 years and it was similar to the result of the Iraqi study by Al-Hadad et al (23) and was in approximation with Chinese studies by Hao et al (11) , Liao et al (15) , and Liu et al (17) , but higher than the median age in a Sudanese study by Hussein et al (24) and lower than Egyptian study by Ali et al (25) .…”

“…In the pediatric group, the male gender was observed more than females and this is in agreement with Iraqi studies by Al-Hadad et al (23) , Shalal et al (26) , Mustafa et al (27) , and Alani et al (28) as well as other studies by Liu et al (17) , Mosaad et al (19) , Hussein et al (24) , and Ali et al (25) .…”

“…In the pediatric group of our study, there is complete remission of (100%) following the induction therapy and this was higher than the result reported by the Iraqi study by Al-Hadad et al (23) , American study by Pasquini et al (29) , Egyptian studies by Mosaad et al (19) , Ali (25) and Shibl et al (30) in approximation with Sudanese study by Hussein et al (24) and this disparity may result from different sample sizes.…”