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Pre-B and 'common' lymphoblastic leukaemia of childhood compared
J S Lilleyman1, R F Hinchliffe
1Department of Haematology, Children's Hospital, Sheffield.
Insights
Pre-B acute lymphoblastic leukemia (ALL) in children presents with distinct pathological features compared to common ALL (C-ALL). While treatment response appears similar, pre-B ALL shows characteristics associated with a poorer prognosis.
Area of Science:
- Pediatric Oncology
- Hematology
- Leukemia Research
Background:
- Acute lymphoblastic leukemia (ALL) is the most common childhood cancer.
- Subtypes of ALL, such as pre-B ALL and common ALL (C-ALL), exhibit varying clinical and pathological characteristics.
- Understanding these differences is crucial for accurate diagnosis and prognosis.
Purpose of the Study:
- To compare clinical and pathological differences between pediatric pre-B ALL and C-ALL.
- To assess if pre-B ALL has unique features that may influence prognosis.
Main Methods:
- Retrospective comparison of 27 children with pre-B ALL and 51 children with C-ALL over 101 months.
- Analysis of clinical presentation, blast cell morphology, immunophenotype, and laboratory markers.
- Evaluation of presenting white cell counts and serum lactic dehydrogenase levels.
Main Results:
- Pre-B ALL cases showed more basophilic blast cells and less periodic acid-Schiff positivity compared to C-ALL.
- Children with pre-B ALL had higher presenting white cell counts and serum lactic dehydrogenase levels.
- Trends suggested younger age and less hyperdiploid blasts in pre-B ALL, but these were not statistically significant.
Conclusions:
- Pre-B ALL, apart from immunophenotype, lacks pathognomonic features distinguishing it from C-ALL.
- However, pre-B ALL exhibits differences in disease characteristics often linked to a worse prognosis.
- Longer follow-up is needed to definitively assess treatment response differences.
Abstract:
Consecutive children suffering from pre-B lymphoblastic leukaemia (pre-B ALL) were compared with those who had 'common' ALL (C-ALL) to assess any clinical and pathological differences between the two groups. Over 101 months 27 pre-B children were seen-an incidence in the population served of around 0.8/100,000 per year. There was some time-clustering and 12 of the 27 presented in one year (1987). The 51 patients with C-ALL who presented for comparison were distributed more evenly over the study period. Pre-B children had more basophilic blast cells with less periodic acid-Schiff positivity. They had higher presenting white cell counts and serum concentrations of lactic dehydrogenase; two variables which were correlated with each other. There was a trend towards pre-B children being younger and fewer had hyperdiploid blasts, but these differences were not statistically significant. No difference from 'common' ALL in response to therapy was apparent for the pre-B patients at a median follow up time of 17 months--too short a period for any conclusion to be drawn. Other than immunophenotype, pre-B ALL has no pathognomonic features, but there are differences from C-ALL in the distribution of some disease characteristics known to be associated with a worse prognosis.