Childhood T-lineage Acute Lymphoblastic Leukemia: Management and Outcome at a Tertiary Care Center in North India.

ABSTRACT

Objective: To assess the clinical features, prognostic factors and outcome of childhood T-ALL in comparison with B-lineage ALL, treated with a uniform treatment regimen (MCP 841). Setting: Pediatric oncology division of a tertiary care institution in Northern India. Design: Retrospective analysis of clinical data and survival outcome. Participants: 60 children with T-ALL and 139 with Blineage ALL, and less than 15 years of age treated over 15 years. Results: T-ALL was observed in 30%. High risk features at presentation (age 10 years, WBC >50,000/mm3, mediastinal mass, and CNS leukemia) were significantly more frequent in T-ALL as compared to B-lineage ALL (P=0.049, P<0.001, P<0.001 and P=0.02, respectively). Fifty five of 60 T-ALL patients (91.7%) achieved complete remission after induction therapy. There were 3 induction and 10 remission deaths while 11 (18.3%) relapsed. The overall survival and event-free survival of T-lineage ALL (61.5±7.6 and 49.9±7.4, respectively) were similar to that of B-lineage patients (68.7±4.7 and 47.1±5.1, respectively). National Cancer Institute risk groups emerged as significant prognostic factor for event free survival only in B-lineage patients. Conclusions: Even though high risk features were significantly more frequent in T-ALL, survival outcome was similar to that of B-lineage patients. None of the routinely described prognostic parameters significantly impacted survival.