RESPONSE RATE OF PAKISTANI CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKAEMIA TO MEDICAL RESEARCH COUNCIL ACUTE LYMPHOBLASTIC LEUKAEMIA 97 CHEMOTHERAPY PROTOCOL
AbstractBackground: Acute lymphoblastic leukaemia (ALL), a malignancy of lymphoid lineage cells, hasexcellent prognosis in children. In Pakistan, a few studies highlighted the response of ALL tochemotherapy. The Present study was planned to see the response rate of Pakistani children with ALLto Medical Research Council ALL 97 (MRCALL97) chemotherapy protocol. This descriptive caseseries was conducted at the Department of Haematology, Armed Forces Institute of Pathology and theDepartment of Paediatric Oncology, Combined Military Hospital, Rawalpindi from 16th of February2007 to 16th of August 2007. Methods: Diagnosed children with ALL fulfilling the inclusion criteriawere interviewed regarding history of the present, past illnesses, and family history. Physicalexamination was performed. Presenting clinical features, blood counts and blood and bone marrowblasts percentage were used to see the response on day 29 post chemotherapy. The data was recordedon a structured proforma for statistical analysis. Results: A total of 33 patients were studied including26 males and 7 females. Twenty-five patients belonged to age group 2–9 years, and 8 to <2 or >9 years,median age being 4.5 years. Presenting WBC count was <50×109/L in 30 patients and >50×109/L in 3patients. At the end of induction, complete remission was achieved in 31 out of 33 (94%) patients whiletwo patients did not achieve remission. Conclusion: Response rate of Pakistani children with ALL tochemotherapy was superior to the previously reported figures from Pakistan.Keywords: Acute Lymphoblastic Leukaemia, ALL, remission, chemotherapy
Ross JA, Davies SM, Potter JD, Robison LL. Epidemiology of
childhood leukemia, with a focus on infants. Epidemiol Rev
Asif MJ, Iqbal Z, Malik A, Hayee A. Trends in childhood acute
leukaemia: Six year experience at Shaikh Zayed Hospital Lahore.
Pak Paed J 2000;24:43–9.
Zahid M, Khalid A, Ahmed Z D, Aziz, Z. Acute leukemias of
childhood: a retrospective analysis of 62 cases. J Pak Med Assoc
Ikram N, Hassan K, Ramzan M, Tufail S, Bukhari K. Leukemias
in children. J Pak Inst Med Sci 2003;14;728–34.
J Ayub Med Coll Abbottabad 2010;22(3)
Khawaja MR, Allana SS, Akbarali AN, Adil SN, Khurshid M,
Pervez S. Flow cytometric and demographic analysis of T cell
acute Lymphoblastic Leukemia in Pakistani population. J Ayub
Med Coll Abbottabad 2005;17:3–8.
Hirt A, Antic V, Wang E, Lüthy AR, Leibundgut K, von der
Weid N, et al. Acute lymphoblastic leukaemia in childhood: cell
proliferation without rest. Br J Haematol 1997;96:366–8.
Hoelzer D, Gale RP. Acute lymphoblastic leukaemia in adults:
recent progress, future directions. Semin Hematol 1987;24:27–39.
Cooke JV. Incidence of acute leukaemia in children. JAMA
Hasle H. Pattern of malignant disorders in individuals with
Down's syndrome. Lancet Oncol 2001;2:429–36.
Hasle H, Clemmensen IH, Mikkelsen M. Risks of leukaemia and
solid tumours in individuals with Down’s syndrome. Lancet
Steinherz PG, Gaynon PS, Breneman JC, Cherlow JM,
Grossman NJ, Kersey JH, et al. Cytoreduction and prognosis in
acute lymphoblastic leukemia-the importance of early marrow
response: report from the Children Cancer Group. J Clin Oncol
van Dongen JJ, Seriu T, Panzer-Grümayer ER, Biondi A,
Pongers-Willemse MJ, Corral L, et al. Prognostic value of
minimal residual disease in acute lymphoblastic leukaemia in
childhood. Lancet 1998;352:1731–8.
Harani MS, Adil SN, Kakepoto GN, Khilji Z, Shaikh U,
Khurshid M. Significance of cytogenetic abnormalities in acute
myeloid Leukemia. J Pak Med Assoc 2006;56:9–13.
Khan AR, Sheikh MH, Intekhab K. Does weight for age have
prognostic significance in children with Acute Lymphoblastic
Leukemia? Pak J Med Sci 2006;22:167–70.
Khan AR, Sheikh MH, Intekhab K. Effect of hypoproteinemia on
treatment outcome in children with acute Lymphoblastic
Leukemia. J Ayub Med Coll Abbottabad 2006;18:53–6.
Anwar M, Ayyub M, Iqbal H. Frequency of Cytogenetic
abnormalities in patients of acute Myeloid Leukemia. Pakistan J
Tahir M, Anwar M, Raziq F. Utility of immunological marker
CD14 in identifying monocytic component in acute Leukemia. J
Postgrad Med Inst 2004;18:553–7.
Idris M, Shah S H, Fareed J, Nasreen G. An experience with
sixty cases of hematological malignancies; a clinico
hematological correlation. J Ayub Med Coll Abbottabad
Qazi RA, Ramzan M. Prognostic factors in Acute Lymphoblastic
Leukemia in adults. J Pak Inst Med Sci 2003;14:720–4.
Ansari SH, Irfan M, Farzana T, Panjwani VK, Shamsi TS. Invivo purging with the anti-CD20 antibody Rituximab along with
standard allogeneic peripheral blood stem cell transplantation
(PBSCT) for relapsed childhood pre - B acute lymphoblastic
leukemia (ALL). J Coll Physicians Surg Pak 2006;16:67–8.
Hashmi KU, Khan B, Ahmed P, Raza S, Hussain I, Ahsan A, et al.
FLAG-IDA in the treatment of refractory/relapsed acute
Leukemias: Single centre study. J Pak Med Assoc 2005;55:234–8.
Kakepoto GN, Burney IA, Zaki S, Adil SN, Khurshid M. Longterm outcomes of acute myeloid leukemia in adults in Pakistan. J
Pak Med Assoc 2002;52:482–6.
Mahmood R, Maqbool S. Management of patients with acute
Lymphoblastic Leukemia comparison and outcome with two
protocols-UKALL-X and modified BFM. Pak J Pathol
Zafar L, Zafar T, Anwar M, Siddiqui SA, Badshah S, Saleem M.
Response to different chemotherapy regimens in childhood acute
lymphoblastic leukaemia: a pilot study. J Coll Physicians Surg
Kamps WA, Bokkerink JP, Hakvoort-Cammel FG, Veerman
AJ, Weening RS, van Wering ER, et al. BFM-oriented treatment
for children with acute lymphoblastic leukemia without cranial
irradiation and treatment reduction for standard risk patients:
(ALL): analysis of the GIMEMA 0496 protocol. Blood
Vilmer E, Suciu S, Ferster A, Bertrand Y, Cavé H, Thyss A, et
al. Long-term results of three randomized trials (58831, 58832,
in childhood acute lymphoblastic leukemia: a
CLCGEORTC report. Leukemia 2000;14:2257–66.