ABSTRACT
To study clinico-haematological features, Laboratory results and prognostic factors in patients of acute lymphoblastic leukaemia. Descriptive study. This study included all newly diagnosed cases of acute lymphoblastic Leukaemia coming to Armed Forces Institute of Pathology Rawalpindi from Jun 2008-Feb2010. The detailed clinical history with physical findings were charted on the proforma. About 3ml blood from each patient was taken in EDTA container. The blood was analyzed on Haematology analyzer Sysmex KX 21. Quality control was maintained by running normal and abnormal controls. Bone marrow aspiration was done at the time of diagnosis. Five push smears were made from each case; 2 for leishman stain, one for Sudan black B, one for periodic cid schiff, and one for acid phosphatase. The common clinical features in children were pallor [100%], fever [93%], hepatomegaly [70%], splenomegaly [64%], lymphadenopathy [58%], bleeding manifestations [27%] and bone pain [9%]. Pallor [100%] and fever [89%] were also common manifestations in adults. Initial high white cell count [> 50x109/l] was observed in 9 [12%] patients. Three patients showed hyperleucocytosis [> 100x109/l]. Haemoglobin < 8gm/dl was seen in 30 11%] patients and platelet count less than 20x109/l was observed in 8 [10.8%] cases. About 9 [12%] patients showed pancytopenia. According to French-American-British [FAB] criteria ALL-L1 was the commonest FAB type [81%], followed by L2 [16%] and L3 [3%] in children while ALL L2 was high among adult age group. We found that ALL is a frequent childhood hematological malignancy in our setting and is more prevalent in males both in children and adults. ALL- L I type being more common than other types of ALL. Considering the prognostic factors of age, WBC count, lymphadenopathy, T immunophenotyping an FAB classification; most of our patients constitute a better prognostic group
ABSTRACT
Acute lymphoblastic leukaemia [ALL] is mainly a childhood malignancy but affects both children and adults. The study was conducted to evaluate a qualitative PCR based method for detection of clonal immunoglobulin gene rearrangement as a marker of minimal residual disease in patients of acute lymphoblastic leukaemia at the end of induction. It was a descriptive study conducted at Armed Forces Institute of Pathology, Rawalpindi from Aug 2009 to Feb 2010. For prospective analysis, genomic DNA was extracted from peripheral blood/bone marrow aspirates and unstained bone marrow smears. A total of 50 patients of acute lymphoblastic leukaemia who showed positive immunoglobulin gene rearrangement by qualitative PCR at the time of diagnosis were included. These patients were then investigated for minimal residual disease at the end of induction. PCR amplification of the IgH gene was done by a VH primer homologous with a highly conserved sequence near the 3´ end of the FR3 region and a consensus sequence JH primer. Test for minimal residual disease was conducted by PCR amplification of DNA from remission marrow cells [at day 29 of chemotherapy] with the help of the primer sets used at the time of diagnosis. The amplified DNA was seen by electrophoresis on 6% polyacrylamide gel. A sharp clonal band ranging from 90-200 bp indicated a positive reaction. Of 50 patients, 28 [56%] were positive for Ig gene rearrangement on PCR at the end of induction, 17 [34%] patients were found to be negative for minimal residual disease, 2 [4%] patients died during induction therapy, and 3 [6%] patients did not come for follow-up. Molecular approaches have allowed us to detect low level of residual disease which is not detected by cytomorphological methods. Minimal residual disease [MRD] by PCR used in this study would definitely help in monitoring of MRD in all patients with leukaemia