Routine blood counts in children with acute lymphoblastic leukaemia after completion of therapy: are they necessary?
Minal Gandhi1, Kanchana Rao, Siew Chua
1Department of Paediatric Haematology and Oncology, Barts and the London NHS Trust, London, UK.
Insights
Routine blood tests for children in remission from acute lymphoblastic leukemia (ALL) rarely detect relapse. Discontinuing these surveillance tests may be safe and improve patient care.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Diagnostics
Background:
- Children completing acute lymphoblastic leukemia (ALL) treatment undergo regular full blood counts (FBCs) for 5 years.
- Evidence supporting the efficacy of surveillance FBCs in detecting unexpected relapse is limited.
Purpose of the Study:
- To evaluate the utility of routine surveillance FBCs in detecting relapse in children treated for ALL.
- To determine if current follow-up practices for childhood ALL are evidence-based.
Main Methods:
- Retrospective analysis of surveillance FBCs from 43 children with relapsed ALL between 1990 and 1999.
- Review of relapse detection methods in children off therapy.
Main Results:
- Only two out of 42 relapses in children off therapy were detected by an abnormal FBC.
- Surveillance FBCs demonstrated low specificity for detecting unexpected relapses in asymptomatic patients.
Conclusions:
- Routine FBCs in asymptomatic children post-ALL therapy lack specificity for detecting unexpected relapses.
- Discontinuation of routine FBCs in this patient population may be safely considered.
Abstract:
Children who have completed treatment for acute lymphoblastic leukaemia (ALL) are commonly followed up for the first 5 years with regular full blood counts (FBCs) to monitor for relapse of disease. There is little evidence to suggest that this practice improves the detection rate of unexpected relapse. Surveillance FBCs, performed on 43 children with relapsed ALL between 1990 and 1999, were analysed. Of the 42 relapses in children off therapy, only two were detected by an abnormal FBC. Routine FBCs in asymptomatic children off therapy lacks specificity in detecting unexpected relapses and maybe safely discontinued.
