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Rates and trends of childhood acute lymphoblastic leukaemia: an epidemiology study
Ameer Kakaje1, Mohammad Marwan Alhalabi2, Ayham Ghareeb2
1Faculty of medicine, Damascus University, Damascus, Syria. ameer.kakaje@hotmail.com.
Insights
This study on childhood acute lymphoblastic leukemia (ALL) in Syria found distinct clinical and laboratory features, highlighting the need for localized treatment protocols. Findings suggest potential for rapid screening using hemoglobin and platelet counts during health crises.
Area of Science:
- Pediatric Oncology
- Hematology
- Epidemiology
Background:
- Childhood acute lymphoblastic leukemia (ALL) is a significant global health concern, particularly in developing nations.
- Prognosis in childhood ALL is influenced by numerous clinical and laboratory factors, necessitating tailored treatment strategies.
- Understanding local epidemiological data is crucial for optimizing management protocols in resource-limited settings.
Purpose of the Study:
- To delineate the clinical and laboratory characteristics of childhood ALL in Syria.
- To identify key prognostic factors and potential disparities compared to international literature.
- To explore the feasibility of using basic hematological parameters for rapid patient prioritization in crisis situations.
Main Methods:
- Retrospective analysis of clinical and laboratory data from 203 pediatric ALL patients (0-14 years).
- Data collected from the Children's University Hospital, Syria's sole major pediatric cancer center during the study period.
- Evaluation of patient demographics, presenting symptoms, ALL subclass, FAB classification, risk stratification, and hematological parameters.
Main Results:
- A male predominance (60.9%) and peak incidence in the 5-9 year age group (48.8%) were observed.
- Common presenting features included lymphadenopathy (82.9%), systemic symptoms (74.9%), T-ALL (20.2%), and L2 FAB classification (36.1%).
- A high proportion of patients presented with abnormal platelet counts (89.3%) or low hemoglobin levels (88.8%); only 2.0% had normal levels for both.
Conclusions:
- Syrian pediatric ALL cases exhibit unique features, including a high prevalence of T-ALL and L2 FAB classification, differing from global trends.
- Normal hemoglobin and platelet counts at presentation were rare, suggesting their utility for rapid screening and prioritization in resource-limited settings.
- Significant deviations in prognostic factors underscore the critical need for locally adapted treatment protocols to improve outcomes in developing countries.
Abstract:
Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer and has a high survival rate when properly managed. Prognosis is correlated with many factors such as age, gender, white blood cell (WBC) count, CD10, French-American-British (FAB) classification, and many others. Many of these factors are included in this study as they play a major role in establishing the best treatment protocol. This study aims to demonstrate clinical and laboratory features of childhood ALL in Syria. They were treated at Children's University Hospital, the only working major cancer centre in Syria at the time of the study. Data of 203 patients who aged 0-14 years were obtained for this study. Most patients (48.8%) aged (5-9) years with a male predominance (60.9%). The major features for ALL included lymphadenopathy (82.9%), presenting with systemic symptoms (74.9%), T-ALL subclass (20.2%), L2 FAB classification (36.1%), low educational levels for fathers (53%) and mothers (56.2%), having a high risk (48.4%), and having a duration of symptoms before evaluation for more than 4 weeks (42.6%). Only three (1.5%) patients had normal full blood counts (FBC) and only one (0.5%) patient had an isolated high WBC count at time of presentation. Most patients had either abnormal platelet count (89.3%) or low haemoglobin level (88.8%) when presenting with only (2.0%) having normal levels for both. This suggests that having normal haemoglobin and platelet count can be used for quick screening in crisis time like in Syria for prioritising patients. Many prognostic factors were significantly different from medical literature which emphasises the importance of local studies in the developping countries. This study included a high prevalence of T-all, L2 FAB classification, high-risk and other variables which require further studies to evaluate the aetiology of these features, especially that treatment protocols may have a higher mortality in developing countries when not adjusted to local variables.
