Impact of the Clinicolaboratory Characteristics on the Treatment Outcome of the Pediatric Patients with Acute Lymphoblastic Leukemia at South Egypt Cancer Institute

BACKGROUND: In pediatric acute lymphoblastic leukemia (ALL), patients are treated according to risk groups
defined by both clinical and laboratory features. We aimed at the identification of the nature of the clinical and
laboratory features that our pediatric ALL patients possess at presentation and the determination of the impact of
these features on the survival rates of them.
METHODS: from January 2008 till January 2014, 172 pediatric patients (102 boys and 70 girls, age 2-15 years
old) with newly diagnosed ALL who presented at the Pediatric Oncology Department, South Egypt Cancer Institute
were analyzed for treatment outcome, disease free- and event free survival rates according to the presenting clinical
and laboratory features. After being submitted for the standard diagnostic workup, the patients were assigned into
standard and high risk groups. The response to treatment was estimated at the specified time points of the treatment
protocol. The treatment outcome, overall - and event free survival rates were statistically calculated at the end of
the study.
RESULTS: favorable age group (2- < 10 years old) represented 76.2%. Mediastinal adenopathy and bulky
extramedullary disease represented 9.9% and 14% respectively. Central nervous system (CNS) involvement with
leukemia was encountered in 3.5% of the patients. Favorable initial WBC count (< 50.000 x109/μL) was found in
70.9%, and B-cell phenotype in 80.8% of patients. We found that favorable age, absence of certain clinical features
as bulky disease; mediastinal adenopathy and CNS leukemia and presentation with favorable WBC count were all
associated with remarkably higher remission rate and significantly lower relapse rate. DFS rate was significantly
higher for patients presented at favorable age and for those who had no bulky disease or mediastinal adenopathy at
presentation.
CONCLUSION: this study showed that presentation with bulky extramedullary disease and mediastinal
adenopathy can confer a negative impact on the remission rate and survival rates of the pediatric ALL patients
treated at Pediatric Oncology Department, South Egypt Cancer Institute. It also showed that gender of the patients
has no remarkable impact on the outcome of these patients.