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A Single Institution's Experience with Cytogenetic and MRD Outcomes in Pediatric Acute Lymphoblastic Leukemia
Asim Amjad1, Rabia Muhammad Wali1, Sadia Anjum1
1Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital, Johor Town, Lahore, Pakistan.
Insights
Cytogenetic type and minimal residual disease (MRD) are crucial for assessing pediatric acute lymphoblastic leukemia (ALL) prognosis. Early detection and risk stratification using these factors improve patient outcomes.
Area of Science:
- Pediatric Oncology
- Hematology
- Genetics
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Accurate prognostic assessment is vital for effective management of pediatric ALL.
- Cytogenetic abnormalities and minimal residual disease (MRD) are known prognostic indicators.
Purpose of the Study:
- To determine the frequency of cytogenetic types in pediatric ALL patients.
- To evaluate the prognostic significance of cytogenetic type and MRD in pediatric ALL.
- To assess the importance of MRD in managing pediatric ALL.
Main Methods:
- Observational study conducted at a Pediatric Oncology Ward.
- Included 150 pediatric patients (aged 1-15 years) diagnosed with ALL.
- Analyzed cytogenetic type and MRD outcomes, excluding patients under one or over 15 years, or with comorbidities.
Main Results:
- TEL-AML (45%) and normal (36%) were the most frequent cytogenetic findings.
- MRD at day 29 was negative in 93% of patients.
- Hyperploid (53%) and euploid (32%) karyotypes were most common; 15% of patients died, primarily from sepsis.
Conclusions:
- Cytogenetic analysis and MRD assessment significantly enhance early risk stratification in pediatric ALL.
- These factors play a vital role in improving the prognostic determination for better management strategies.
Objective:
To determine the frequency of cytogenetic type and its significance in the prognostic outcome of the pediatric patients in acute lymphoblastic leukemia (ALL), aged 1 to 15 years, and also determine the importance of minimal residual disease (MRD) in the management of the condition.
Study Design:
An observational study.
Place And Duration Of Study:
Pediatric Oncology Ward, Shaukat Khanum Cancer Hospital, Lahore, from January 2015 to July 2017.
Methodology:
Patients aged 1-15 years, diagnosed with ALL, were included. Studied variables were cytogenetic type and MRD outcome in patients with ALL. Patients under one year of age and more than 15 years, or those having comorbidities, were excluded.
Results:
Total 150 patients' data were retrieved from the Hospital database. One hundred and thirty-three belonged to age 1 to 5 years group (89%) and 17 (11%) were in 5 to 10 years group. The mean age of the patient was 4.3 +3.1 years. One hundred and two (68%) were males; whereas, 48 (32%) were females. Pre B acute lymphoblastic leukemia was diagnosed in 139 (93%) patients and 11(7%) were diagnosed with Pre T acute lymphoblastic leukemia. Standard risk was observed in 120 (80%) patients and 30 (20%) patients were on high risk as per National Cancer Institute (NCI) Guidelines. Regimen A was used in 125 (83.3%), Regimen B in 16 (10.7%), and Regimen C in 9 (6%) patients. BCR-ABL was positive in 2 (1.30%), TEL-AML in 68 (45%), MLL in 5 (3.30%), and normal in 54 (36%). MRD at day 29 was negative in 40 (93%) and positive in 3 (7%). The karyotyping was done in 128 (85%) patients, out of which 68 (53%) were hyperploids, 41 (32%) euploid, and 19 (15%) were hypoploid. Death was observed in 22 (15%) patients. Nineteen (86%) deaths were due to fungal and bacterial sepsis; and disease-related deaths were noted in 3 (14%) patients.
Conclusion:
The role of MRD and cytogenetics in risk assessment has improved in the early prognosis determination.