Karyotype in pediatric acute lymphoblastic leukemia : impact on clinical presentation and duration of first remission

الملخص EN

Purpose : in this study we are aiming at investigating the correlation between karyotype and the clinic pathologic features of pediatric acute lymphoblastic leukemia, duration of first remission and outcome of patients.

Material and Methods : A total of 40 pediatric patients with the diagnosis of acute lymphoblastic leukemia (ALL) were included in this study.

The patients were treated according to ALL P.NCI III / 98 protocols used at the Pedi-atric Oncology Unit, National Cancer Institute, Cairo University.

Results : Analyzing the patients with respect to their chromosomal pattern; the majority of patients (17 / 40, 42.5 %) showed a pseudo diploid karyotype.

Their mean age was 10.2 ± 4.8 years, M/F ratio 2.4:1.

Massive hepatosplenomegaly (HSM) was encountered in 64.7%.

The mean total leucocyte count (TLC) was 66.53±5.2 cells per µl.

Their mean first complete remission (CR1) was 11.05±2.3 months, EFS was 40 % at 12 months and 17.78 % at 24 months.

Patients with normal karyotype came next, representing 13 / 40 (32.5 %).

Their mean age was 8.4 ± 1.8 years, M / F 0.8 : 1.

Massive HSM was found in 62.5%.

The mean TLC was 78.74±3.8 cells per µl.

Their mean CR1 was 11.62±1.2 months, EFS was 41.67 % at 12 months and 33.33% at 24 months.

The third group represented patients with hyperdiploidy (8 / 40 ; 20 %).

Their mean age was 8.8 ± 3.1 years, M/F 7:1.

Massive HSM was found in 50%.

The mean TLC was 45.16 ± 3.1 cells per µl, their mean CR1 was 18.10±3.4 months, EFS was 75 % at 12 months and 62.5 % at 24 months.

The least group showed a hypo diploid pattern (5 / 40 ; 12.5 %).

Their mean age was 13±2.6 years, all were males.

Massive HSM was encountered in 100 %.

The mean TLC was 20.00 ± 2.9 cells per µl.

Their mean CR1 was 10 ± 2.8 months.

Conclusion : Egyptian patients with childhood ALL who have hyper diploid karyotype, especially those having > 50 chromosomes carry a better prognosis than patients with other chromosomal abnormalities.

Pseudo diploid karyotype is the most frequent among Egyptian ALL cases and this could be the reason for our overall poor treatment results.

Normal karyotype cannot be used as a prognostic parameter in ALL cases.

Hypo diploid karyotype carries the worst prognosis.