RESPONSE OF INDUCTION THERAPY IN DIFFERENT IMMMUNOLOGICAL SUBTYPES OF ACUTE LYMPHOBLASTIC LEUKEMIA IN CHILDREN

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Muhammad Ihtesham Khan
Sunia Arif Khan
Salim Ur Rahman
Nuzhat Yasmeen

Abstract

Objective: To analyse response of induction chemotherapy in different immunological subtypes of acute lymphoblastic
leukemia in children.
Material and Methods: This cross sectional study was conducted at the Department of Pathology, Pakistan Institute of
Medical Sciences (P.I.M.S), Islamabad, Pakistan from June 2014 to September 2015. A total of 51 children ranging from
1-13 years of age, and diagnosed with ALL were included in the study. Immunophenotyping was recorded. All patients
were given chemotherapy according to the BFM (Berlin-Frankfurt-Münster) protocol in the Oncology Department P.I.M.S.
During induction therapy, 10 patients died. Remaining 41 patients received a complete course of induction therapy.
Response to induction therapy was determined in these 41 patients by counting blast cells in the bone marrow at the
end of induction therapy. Patients having <5% blasts are said to have achieved complete remission, while those having
>5% blast cells are said to be in remission failure. Remisson pattern was used to assess the response of induction
chemotherapy in different immunophenotypes of ALL and conclusions were drawn accordingly.
Results: Out of 51 patients , 10 patients died during induction therapy. Remaining 41 patients received complete course
of induction therapy. These 41 patients were analysed for response of induction therapy. Out of 41 patients, there were
27 (65.9%) males and 14 (34.1%) females. Out of 41 patients of ALL, 36 (87.8%) patients had Precursor B-cell ALL, 3
(7.3%) patients had T-cell ALL, while 2 (4.8%) patients had Precursor T-cell ALL. So, 36 (87.8%) patients had B-lineage
ALL, while 5 (12.2%) patients had T-lineage ALL. Out of 41 patients, 37 (90%) patients showed complete remission at
the end of induction therapy, while 4 (10%) patients were not in complete remission. Out of 36 patients of Precursor
B-cell ALL, 33 (91.7%) were in complete remission, while 3 (8.3%) were not in remission. There were 2 patients of
Precursor T-cell ALL and both of them achieved complete remission. There were 3 patients of T-cell ALL. Two of them
achieved complete remission, while 1 faced induction failure. Out of 10 patients who died during induction therapy, 5
(50%) patients died due to intracranial bleeding, and 4 (40%) patients died due to sepsis. Tumor lysis syndrome was
observed in 1 (10%) patient. Bleeding was the common cause of death.
Conclusions: The present study showed that response to induction therapy is better in Precursor B-cell ALL as compared
to T-cell ALL. It was also found that the rates of complete remission are lower in our setup. Induction death rate
is high in our setup due to delayed platelet and blood transfusions, poor socioeconomic status,and lack of knowledge
about the disease in population

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