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Cytomorphological determinants of prognosis in acute lymphoblastic leukemia of children
Insights
Cytomorphology of leukemic cells in bone marrow can predict outcomes in pediatric acute lymphoblastic leukemia (ALL). Larger cell size and prominent nucleoli indicate poor prognosis, aiding risk stratification for better treatment strategies.
Area of Science:
- Hematology
- Pediatric Oncology
- Cytopathology
Background:
- Predicting disease outcome in pediatric acute lymphoblastic leukemia (ALL) is crucial for effective treatment planning.
- Traditional risk stratification in ALL relies on factors like age and white blood cell count at diagnosis.
- Morphological features of leukemic cells may offer additional prognostic information.
Purpose of the Study:
- To evaluate the predictive value of cytomorphological criteria in bone marrow smears for outcomes in children with ALL.
- To determine if cell size and nucleolar characteristics can identify 'poor risk' patients.
- To assess the independence of cytomorphological risk from other known prognostic factors.
Main Methods:
- Analysis of Romanowsky-stained bone marrow smears from 93 children diagnosed with ALL.
- Assessment of leukemic blast cell size (relative to red blood cells) and nucleolar size/prominence.
- Correlation of cytomorphological findings with patient survival data and other risk factors (age, leukocytosis).
Main Results:
- Forty-eight 'poor risk' patients were identified based on blast cells exceeding twice the diameter of red blood cells and/or >1 visible nucleolus per two leukemic cells.
- The 'poor risk' group had significantly worse survival (median 18 months) compared to the 'good risk' group (median >5 years) (p=0.0036).
- Cytomorphological risk was found to be independent of age and leukocytosis at diagnosis.
Conclusions:
- Specific cytomorphological features (cell size, nucleolar prominence) are valuable independent predictors of outcome in pediatric ALL.
- This method may be more reproducible and identify a higher proportion of 'poor risk' patients than other existing methods.
- Periodic acid-Schiff (PAS) positivity may serve as an additional useful prognostic criterion.
Abstract:
In children with ALL, the appearance of leukemic cells in stained spreads can be useful in predicting outcome of the disease. Cell size and nucleolar size and prominence are the two criteria, detectable on Romanowsky-stained bone marrow spreads, which permit such prediction. In a series of 93 children with ALL, 48 "poor risk" patients were detected. More than 1% of the bone marrow blast cells of these patients exceeded in diameter twice the diameter of nearby red blood cells, and, on average, more than one nucleolus was visible in every two leukemic cells. The survival of these 48 patients (estimated median 18 mo) was significantly worse (p = 0.0036) than that of the other 45 patients (estimated median over 5 yr). Analysis of the series with respect to other risk factors (age, leukocytosis at diagnosis) revealed the cytomorphological risk to be independent of the other two. Comparison of this method with others which have been used suggests that the proposed method may be more reproducible (capable of being learned) than others because it relies on specific characteristics rather than on total recognition of a "cell type," and that it may select a higher proportion of "poor risk" patients than other methods. PAS-positivity may be a useful additional criterion.