DOI QR코드

DOI QR Code

Acute Lymphoblastic Leukemia in Adults - an Analysis of 51 Cases from a Tertiary Care Center in Pakistan

  • Sultan, Sadia (Department of Hematology & Blood bank, Liaquat National Hospital and Medical College) ;
  • Irfan, Syed Mohammed (Department of Hematology & Blood bank, Liaquat National Hospital and Medical College) ;
  • Parveen, Saira (Department of Hematology & Blood bank, Liaquat National Hospital and Medical College) ;
  • Mustafa, Sanober (Liaquat National Medical College)
  • Published : 2016.06.01

Abstract

Background: Acute lymphoblastic leukemia (ALL) is a malignant disease in which early lymphoid precursors proliferate and replace the normal hematopoiesis. It has distinctive clinical and biological features. In respect to adult ALL, available data from Pakistan are limited. Therefore we reviewed the demographical and clinicohematological profiles along with FAB stratification of adult patients with ALL presented at our hospital. Materials and Methods: In this cross sectional study, 51 adults (${\geq}15years$) patients with ALL were enrolled from January 2010 to December 2014. Results: The mean age was $23.8{\pm}12.9years$ with the median age of 18.0 years. The male to female ratio was 2:1. The major complaints were fever (60.7%), generalized weakness (47.0%), overt bleeding (19.6%) and weight loss (13.7%). Physical examination revealed lymphodenopathy as a predominant finding detected in 43.1% followed by splenomegaly and hepatomegaly in 23.5% and 21.5%, respectively. The mean hemoglobin level was $9.0{\pm}2.75g/dl$ with a mean MCV of $82.2{\pm}15.4fl$, a mean total leukocyte count of $31.1{\pm}64.0{\times}10^9/l$, a mean ANC of $2.1{\pm}3.0{\times}10^9/l$ and a mean platelet count of $71.7{\pm}85.7{\times}10^9/l$. According to FAB classification, 47.1% were L1 type, 45.1% L2 and 7.8% L3 variant. Conclusions: Clinico-pathological features appeared comparable to published data. Febrile illness associated with lymphodenopathy was the commonest presentation. FAB classification revealed a predominance of ALL-L1 variant in Pakistani adult patients with ALL.

Keywords

Acute lymphoblastic leukemia;adults;Pakistan

References

  1. Asif N, Hassan K (2013). Acute Myeloid Leukemia amongst Adults. J Islamabad Med Dental College, 2, 58-63.
  2. Bennettt JM, Catovsky D, Daniel MT (1976). Proposals for the classification of the acute leukaemias. French-American-British (FAB) co-operative group. Br J Haematol, 33, 451-8. https://doi.org/10.1111/j.1365-2141.1976.tb03563.x
  3. De Franca Azevedo I, da Silva Junior RM, de Vasconcelos AV, et al (2014). Frequency of p190 and p210 BCR-ABL rearrangements and survival in Brazilian adult patients with acute lymphoblastic leukemia. Rev Bras Hematol Hemoter, 36, 351-5. https://doi.org/10.1016/j.bjhh.2014.07.016
  4. Elyamany G, Awad M, Alsuhaibani O, et al (2014). FLT3 Internal Tandem Duplication and D835 Mutations in Patients with Acute Lymphoblastic Leukemia and its Clinical Significance. Mediterr J Hematol Infect Dis, 6, 2014038. https://doi.org/10.4084/mjhid.2014.038
  5. Greaves M (2006). Infection, immune responses and aetiology of childhood leukaemia. Nat Rev Cancer, 6, 193-203. https://doi.org/10.1038/nrc1816
  6. Goud TM, Al Salmani KK, Al Harasi SM, et al (2015). Importance of FISH combined with morphology, immunophenotype and cytogenetic analysis of childhood/ adult acute lymphoblastic leukemia in omani patients. Asian Pac J Cancer Prev, 16, 7343-50. https://doi.org/10.7314/APJCP.2015.16.16.7343
  7. Hassan K, Ikram N, Shah SH (1994). A morphological pattern of 234 cases of leukemias. J Pak Med Assoc, 44, 145-8.
  8. Hayakawa F, Sakura T, Yujiri T, et al (2014). Markedly improved outcomes and acceptable toxicity in adolescents and young adults with acute lymphoblastic leukemia following treatment with a pediatric protocol: a phase II study by the Japan Adult Leukemia Study Group. Blood Cancer J, 17, 4-252.
  9. Islam N, Rahman MM, Aziz MA, et al (2014). Clinical and haemato-pathological characteristics of adult acute lymphoblastic leukaemia. Mymensingh Med J, 23, 281-5.
  10. Jemal A, Siegel R, Ward E, et al (2006). Cancer statistics.CA Cancer J Clin, 56, 106-30. https://doi.org/10.3322/canjclin.56.2.106
  11. Jiang Y, Hou J, Zhang Q, et al (2013). The MTHFR C677T polymorphism and risk of acute lymphoblastic leukemia: an updated meta-analysis based on 37 case-control studies. Asian Pac J Cancer Prev, 14, 6357-62. https://doi.org/10.7314/APJCP.2013.14.11.6357
  12. Khalid A, Zahid M, Rehman A, et al (1997). Clinicoepidemiological features of adult leukemias in Pakistan. J Pak Med Assoc, 47, 119-22.
  13. Mashhadi MA, Koushyar MM, Mohammadi M (2012).Outcome of adult acute lymphoblastic leukemia in South East of iran (zahedan). Iran J Cancer Prev, 5, 130-7.
  14. Malhotra P, Varma S, Varma N, et al (2007). Outcome of adult acute lymphoblastic leukemia with BFM protocol in a resource-constrained setting. Leuk Lymphoma, 48, 1173-8. https://doi.org/10.1080/10428190701343255
  15. NCCN-National comprehensive cancer network, clinical practice guidelines in oncology, acute lymphoblastic leukemia, version 2015, MS2.
  16. Pui CH, Robison L, Look AT (2008). Acute lymphoblastic leukemia. Lancet, 354, 166-178.
  17. Seiter K (2014). Sarkodee-Adoo, C; Talavera, F; Sacher, RA; Besa, EC, ed. "Acute Lymphoblastic Leukemia". Medscape Reference. WebMD. Retrieved 17 April 2014.
  18. Sabir N, Iqbal Z, Aleem A, et al (2012). Prognostically significant fusion oncogenes in Pakistani patients with adult acute lymphoblastic leukemia and their association with disease biology and outcome. Asian Pac J Cancer Prev, 13, 3349-55. https://doi.org/10.7314/APJCP.2012.13.7.3349
  19. Shaikh MS, Adil SN, Shaikh MU, Khurshid M (2014). Frequency of chromosomal abnormalities in Pakistani adults with acute lymphoblastic leukemia. Asian Pac J Cancer Prev, 15, 9495-8. https://doi.org/10.7314/APJCP.2014.15.21.9495
  20. Shahab F, Raziq F (2014). Clinical presentations of acute leukemia. J Coll Physicians Surg Pak, 24, 472-6.
  21. Tong H, Zhang J, Lu C, et al (2010). Immunophenotypic, cytogenetic and clinical features of 113 acute lymphoblastic leukaemia patients in China. Ann Acad Med Singapore, 39, 49-53.
  22. Wartenberg D, Groves FD, Adelman AS (2008). Acute lymphoblastic leukemia: epidemiology and etiology. In: Estey EH, Faderl S, Kantarjian H, eds. Acute Leukemias. 1st ed. Berlin, Germany: Springer; 2008, 77-93.