Pediatric Infectious Diseases: Open Access

Clinical characteristics and treatment outcome of children with Philadelphia chromosome positive acute lymphoblastic leukemia – experience from tertiary care center from South India

Background:About 3–5% of paediatric patients with acute lymphoblastic leukemia (ALL) have t(9;22)(q34;q11.2) translocation known as the Philadelphia chromosome (Ph). Outcomes of children treated with intensive chemotherapy along with Imatinib are comparable to HSCT. There is limited data about outcome of patients treated with imatinib combined with chemotherapy in developing countries.

Methods:Children of ≤14 years of age, diagnosed as Ph+ ALL from January 2013 to December 2017, were included for retrospective analysis. 2 year event free survival (EFS) and overall survival (OS) were noted and outcomes were correlated with NCI risk group, LDH level.

Results:Seventeen children were diagnosed as Ph+ ALL. This included 16(94%) children of B ALL and 1 child (6%) of mixed phenotypic ALL (MPAL). Mean age was 96 months (Range 42-156). There were 13 (76%) and 4 (24%) children with NCI high and low risk criteria, respectively. Fourteen (82%) children received imatinib, while 3 (18%) children died before receiving imatinib. Seven children relapsed, one had very early combined relapse, two children had early bone marrow (BM) relapse, three children had early combined relapse and one child had late BM relapse. Total 11 children died, seven due to relapse and four due to treatment related mortality. At median follow up of 23 months (Range 0-61), 2 year EFS and OS for study group were 57.8% and 64.2%, respectively. 2 year OS for children with NCI high and low risk was 61.5% and 75%, respectively (p=0.656). 2 year OS for children with lactate dehydrogenase (LDH) level ≤2000 and >2000 IU/dL was 55.6% and66.7%, respectively (p=0.945)

Conclusion:2 year EFS and OS in India are lower than western countries. Tumour burden or NCI high risk criteria did not affect survival. India. He has two publications in international journals. Apart from academics he loves to indulge himself in music, writing poems and eco and cultural tourism

Author(s):

Maharshi Trivedi, MGM Medical College and MY Hospital, Indore

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