Characteristics and survival rates of Acute Lymphoblastic Leukemia: A Retrospective cohort study

Abstract

Background: Acute lymphoblastic leukemia (ALL) is the most common hematologic neoplasm in childhood, whereas it makes up for almost 20% of leukemias in adults. Despite the many reports about the outcomes and prognostic factors from developed countries; such reports are rare in the Middle East.

Methods: This is a retrospective study of newly diagnosed and previously untreated acute lymphoblastic leukemia patients who were admitted to the oncology department in Tishreen University Hospital in Latakia, Syria between 2007 and 2016. Patients of all ages were enrolled in the study. Patient data were collected, including: Age, gender, area of residence, laboratory results, existence of visceral or nodular enlargements on CT-scan, ALL subtype and CD10 expression. We listed which chemotherapeutic regimen was used. The initial response post-induction was documented based on minimal residual disease. Finally, survival rates were calculated after 5 years of diagnosis. The ending point was confirmed death.

Results: This study included 129 patients. The number of males was 82. Complete remission after the first induction was achieved in 66 patients (51.2%), and 54 patients died during the five year observation period. B-lineage ALL was predominant, with pre-B-ALL being the most common subtype (27.9%). The best survival rates were seen in ages 1 to 13. There rates dropped gradually with age. A WBC count higher than 50 10*3/µL was associated with lower survival rates. Pre-B and common B subtypes had the highest survival rates, while cortical and pre-T subtype leukemias had the worst. Patients with a positive CD10 expression had better survival rates. Finally, achieving complete remission after the first induction had a statistical; but not a clinical prognostic value. Other variables such as gender, HGB, PLT, radiographic findings and regimens didn’t have any effect on survival.

Conclusion: Age, WBC count at diagnosis, ALL subtype, CD10 expression and achieving complete remission after the first induction are all considered prognostic factors in acute lymphoblastic leukemia patients. Thus, they could be useful indicators in risk stratification of the disease, while we couldn’t find a reliable chemotherapeutic regimen which improved survival rates significantly. Therefore, this matter needs further investigation by clinicians.