Clinico-epidemiological study of leukemia in Multan

ABSTRACT

In order to find out the clinico-epidemiological aspect of leukaemia, 105 patients of leukaemia admitted in three Departments of Medicine, as well as Department of Paediatric Medicine and Oncology of Nishtar Hospital, Multan between November, 1982 and June, 1986 were studied. Out of 105 cases of leukaemia, 63 patients [60%] had chronic leukaemia, 38 patients [36.19%] had acute, leukaemia and 4 cases [3.81%] belonged to miscellaneous group [multiple myeloma]. The commonest type leukaemia seen was chronic non-lymphocytic leukaemia or myeloid type [CML], which constituted 47.8% of total cases; 22.9% were acute lymphoblastic leukaemia [ALL]; 13.3% had acute non-lymphoblastic leukaemia [ANLL/AML] 12.4%; had chronic lymphocytic leukaemia [CLL] and 3.6% belonged to miscellaneous group. Among males, half of the cases of leukaemia, both acute and chronic, were seen in 11-40 years of age groups, while in females, half of the cases were in 21-40 years of age group. Out of acute leukaemias, ALL was common in first decade and ANLL/AML in the second decade. Out of chronic leukaemias, CLL was seen in all the age groups, while.-CML was not seen in the first decade. Majority of the patients [91.9%] belonged to low income group, 8% to middle class, while remaining had a higher social status. The exact cause of leukaemia in this area is not clear. The disease is common in poor population and in the males. Not a single case of leukaemia belonged to area of Dera Ghazi Khan where uranium deposits are reported Although leukaemia is reported in those persons who are exposed to non-ionizing radiations from electromagnetic fields and metal fumes, yet only one case of the present series had this type of profession. The role of drugs in the pathogensis of leukaemia in the present series is not clearly established. Majority of cases of leukaemia were from Multan and Sahiwal Districts, where no uranium deposits are reported. Out of 38 cases of acute leukaemia, Total Leucocytic Count [TLC], was less than 100,000/ul in 36 patients, while in only 2 cases of ALL, TLC was above 100,000/ul. In 70% cases of CML and 50% cases of CLL, TLC was 100, 000 and 400,000/ul. Platelets in all cases of chronic leukaemia were more than 100,000/ul except 2 cases, who were in blastic crisis and their platelet count was very low. Both of them had bleeding tendency. Raised serum uric acid leves were seen in 7 out of 50 cases of CML and one out of 13 cases of CLL. Serum uric acid level was normal in all cases of acute leukaemias except in 2 cases of ALL, who had raised serum uric acid level. The common clinical features in acute leukaemias included fever, bleeding tendencies, while masses in the neck and axillae, pains and aches, weakness, mouth ulcers and pallor was also seen. In CLL, enlarged liver, enlarged spleen, fever, lymphadenopathy, masses in the abdomen were seen in this order of occurrence while in CML, enlarged spleen, enlarged liver and spleen, enlarged lymph noes and anaemia were seen. Chemotherapy and radiotherapy were the methods of treatment. Since most of the drugs are costly and not supplied by the hospital, it was at times not possible to give full chemotherapy as majority. Complete follow up of the cases could not be possible due to non-cooperation of the patients and their relatives. Prognosis was bad, especially in cases of AML as bone marrow transplantation facility does not exist in this country