A Study of Clinico-Pathological Profile and Correlation of Outcome with Risk groups of Pediatric Patients with Acute Lymphoblastic Leukemia at a Tertiary Care Centre in North East India

Abstract

Introduction: Outcome data on Acute Lymphoblastic Leukemia (ALL) treatment remain scarce in developing nations. This retrospective study from the Tata Memorial Centre, Northeast India, aimed to explore the clinical and pathological profiles and to correlate the outcome with risk groups in pediatric patients of ALL in this region.

Materials and methods: A retrospective analysis of 418 children newly diagnosed with ALL between May 2015 and April 2020 treated with ALL-IC BFM 2002 protocol was performed.

Results: Mean age was 7.09 years and median age was 6 years. Most patients were of the Intermediate Risk group. 93 (22.25%) patients had relapse. 72 (17.22%) patients died. After a median observation period of 61 months, the 5-year Event Free Survival (EFS) and Overall Survival (OS) were 69.5% and 72.3% for all patients respectively. Patients in the age group of 1-5 years had significantly better EFS and OS (74.6% and 82.2 %, respectively) than in those of ≥6 years (62.7% and 69.8%) (P=0.032 and P=0.043 respectively). Patients with B ALL had significantly better EFS and OS (72.6% and 75.8%, respectively) than those with T-ALL (57.8% and 59.1%) (P=0.011 and P=0.021, respectively). Patients who had initial leukocyte counts of <20×10⁹ /L had better EFS and OS (78.4% and 85.5 % vs 56.6% and 64.8%) (P=0.002 and P=0.012, respectively). Children with a good response to prednisone on day 8 achieved higher EFS and OS (77.7 % and 83.7 % vs. 29.5% and 36.4 %) (P=0.000 and P=0.012). The 5-year EFS and OS were 76.1% and 85.9% for the Standard Risk group,70.3% and 78.6% for the Intermediate Risk group, and 50.2% and 57.4% for the High Risk group (P=0.001 and 0.032, respectively). There was no significant association between sex and survival rates (P=0.731).

Conclusion: The study demonstrates that, with proper risk stratification and corresponding treatment modifications, it is feasible to administer an effective regimen in India and to achieve satisfactory event-free and overall survival outcomes.