Immediate Outcome of Acute Leukemia Following Induction Chemotherapy in Relation to Clinical and Laboratory Profile

Md. Abdul Wohab1, Md. Selimuzzaman2 , Md. Mamun Mia3, Nilufar Akhtar Vanu Chowdhury4

Background: Acute lymphoblastic leukaemia (ALL) is the most common paediatric
malignancy. It represents 25% of all childhood cancers and approximately 75% of all
cases of childhood leukaemia.
Objectives: Study objective was to see the bone marrow remission pattern at the end
of induction therapy in paediatric ALL and AML patients.
Methods: It was an observational study and conducted at Paediatric Haematology
and Oncology Department, Dhaka Shishu Hospital, July 2013 to June 2014. Thirty
pediatric ALL patients and 10 AML patients were included in the study. Diagnosis
was based on history, examination findings, peripheral blood film and bone marrow
study. According to UK ALL 2003 protocol all patients were given 4-drug induction
therapy, i.e., vincristine, prednisolone, L-asparagenase and daunomycin and for AML
‘3+7’ regimen given for 2 cycles. Bone marrow study was repeated at day 28 of induction
therapy and remission pattern was seen.
Results: Out of 40 Patients, 27(67.5%) were males. Age range was between 1–12
years (Mean 5.4 years). Bone Marrow study was done in 40(100%) patients. At day 28
of induction therapy, 24 (60%) patients went into complete remission (<5% blast cells
in bone marrow), 10 (25%) into partial remission (5–25% blast cells in bone marrow).
Total six (15%) patients,3 from each group (ALL and AML) died due to febrile
neutropenia and sepsis during the course of induction therapy.
Conclusion: Outcome of ALL after induction therapy using modified ‘UK ALL-99’
regime in this study was below the anticipated response rates of developed countries,
but in case of AML outcome of induction therapy using 2 cycles of ‘3+7’ regime (with
cytarabin and daunomycin), was not satisfactory. The outcome was affected by age
and sex of the patient, initial WBC and Platelet count and blast cells in the bone
marrow during diagnosis.
Keywords: Acute Leukemia, induction therapy chemotherapy

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