Qalab abbas, MBBS
Assistant Professor
Aga Khan University
Karachi, Saskatchewan, United States
Disclosure information not submitted.
Anwar Haque, MD
Professor
Liaquat National Hospital, United States
Disclosure information not submitted.
Title: Clinical Significance of Peripheral Blast Clearance in Children with Hyperleukocytic-Acute Leukemia
Objective: To evaluate the clinical significance of Peripheral Blast Clearance (PBC) in Children with Hyperleukocytic-Acute Lymphoblastic Leukemia (H-ALL).
Methods: Retrospective review of medical record of all children (age 1-18yrs) with H-ALL who were diagnosed and treated during 2017-2019 in a large tertiary-care pediatric oncology center was done. All children were treated by Berlin-Frankfurt-Munster (BFM) -based protocol where prednisolone prophase with 60 mg/m2 per day was given for a week followed by risk stratified chemotherapy. PBC is defined as zero blast on peripheral smear examination at Day-8 Complete Blood Count (CBC) and it is considered as Complete Remission (CR), which was correlated with post induction (Day-28) Minimal Residual Disease on bone marrow aspirate.
Results: 104 children with H-ALL were enrolled. The mean age was 8.12±4.0 years and 74% were male. The mean White Blood Cell count was 272.6±180.4 103/µL (Blast cell 86.4%). 42% has mediastinal mass. T-cell and B-cell ALL were 57% and 43% respectively. The PBC was achieved in only one-fourth of patients (n=24). Persistence of blast in peripheral blood after day 11 and onward is less likely to go in complete remission.
Conclusion: The PBC in children with H-ALL can be identified as an additional prognostic factor in early response to therapy. CBC is simple, inexpensive, non-invasive and reliable measurement and may help in guiding the risk-stratification