الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute leukeimas represent clonal expansion and arrest at specific stage of normal myeloid or lymphoid hematopoiesis. They constitute 97% of all childhood leukemias. Acute lymphoblastic leukemia (ALL) constitutes 75% of acute leukemias, AML accounts for 15–20% of pediatric leukemia and Acute MLLs represent 2–5% of acute leukemia. There are impressive advancements in childhood leukemia treatment, studies have reported marked disparities in the survival of children living in high income countries (HIC) versus low & middle income countries (LMIC) in both ALL and AML.
Studies of cancer epidemiology in LIMC represent a key element for progress. Hospital-based registries are both feasible and essential. The registration of childhood leukemia requires recognition of symptoms, rapid access to primary and tertiary medical care (a pediatric cancer unit), a correct diagnosis, and a data management infrastructure. The aim of the work is to assess statistically the cases of acute leukemia; their types, clinical course and outcome.
This study was carried out on patients diagnosed with acute leukemia in Alexandria University Children’s Hospital (AUCH) during three years (from 1/1/2014 to 31/12/2016). Two hundred and forty patients were diagnosed during the studied period, 82 patients (34.2%) were referred for treatment in other hospitals upon their request, while 158 patients were treated in the Hematology and oncology unit at AUCH.
The available data about the referred group were limited to the demographic data, date of diagnosis and type of leukemia; the males presented 54.9% (45 patients), while the females represented 45.1% (37 patients), according to their age group 62 patients (75.6%) were from 1-10 years of age, 16 patients (19.5%) were more than 10 years of age and 4 patients (4.9%) were less than 1 year of age, (63.8%) were ALL, (34.8%) AML and (1.4%) patient had bi-phenotypic leukemia.
The treated group presented 65.8% of the patients diagnosed in the studied period; 75 patients were males and 83 patients were females, with a male to female ratio of 1:1.1, according to their age group 134 patients (84.8%) were from 1-10years of age, 14 patients (8.9%) were more than 10 years and 10 patients (6.3%) were less than 1year age. The median age was 4 years the youngest was 5 month and the eldest was 13 years. Most of the acute leukemia patients in this study were diagnosed between the age 1 year to 10 years, but there was no statistical significance relation between the age at presentation and the type of acute leukemia diagnosed. The patients represented the 4 main Governorates referring to the hematology/oncology unit of AUCH namely Alexandria (45, 36.8%), Beheira (59, 48.4%), Kafr el-Sheikh (8, 6.6%), Matrouh (10, 8.2%) and one case was not from Egypt, 59 patients were from urban areas and 70 patients were from rural areas, but there was no statistical significant relation between the type of acute leukemia presented and the area of residency whether urban or rural.
This study showed that there was a statistically significant relation between the type of acute leukemia diagnosed in certain months of the year; ALL patients were more presented in the interval October- December while, AML patients were more presented in the interval July to September.
The presenting symptoms and signs recorded for the treated group were: pallor in 105 patients (66.5%), Petechiae /ecchymosis in 94 patients (59.5%), fever in 94 patients (59.5%), bone pain in 35 patients (22.2%), hepatomegaly/splenomegaly in 88 patients (55.7%) and lymphadenopathy in 71 patients (44.9%). There were other presentations recorded beside these common presentations in 39 patients and 2 patients were diagnosed with AML on top of Fanconi anemia, 3 patients diagnosed with B-ALL on top of down syndrome (DS) and a case diagnosed with AML M7 (age < 1 year) had active rickets.
The median WBC was 23.5 x103/uL, ranging from 0.7to 989 x103/uL. The median hemoglobin was 7 gm/dl, ranging from 3.7 to 13 gm/dl. The median platelets count was 50 x103/uL, ranging from 8 to 332 x103/uL. Ninety five patients (63.3%) were presented with initial WBC less than 50,000 cells/uL, 38 patients (25.3%) with initial WBC more than or equal 50,000 cells/uL and 17 patients (11.4%) with hyperleukocytosis, there were statistical significant relations between the initial WBC count and the type of acute leukemia diagnosed and also the induction outcome.
One hundred and twenty nine patients (81.6%) were diagnosed as ALL, 28 (17.7%) AML and one case (0.6%) AMLL (biphenotypic). The ALL patients were 102 patients (79 %) B-ALL, 20 (15.5 %) T-ALL and 7 (5.5 %) infant B-ALL. Cytogenetic was not routinely indicated in the implemented protocols during the studied period. CNS leukemia were present in 38 patients (29.9 %) of the treated group.
Chest X-ray and U/S abdomen were routinely done in all of the treated patients. Echocardiogram were indicated in certain patients of the treated group, also advanced imaging as CT scan and MRI were done in some patient.
The treatment protocols (in the appendix) used were unified according to the type of leukemia diagnosed and also according to the risk stratifications in the ALL patients, MRD played no role in the protocol used during the period of the study. Only isolated bone marrow relapses were recorded in the studied period, different protocols were used in treatment of relapse (in the appendix), all the relapsed patients in this study died except for a patient who proceeded to BMT and a patient still on chemotherapy for relapse. Four patients had failure of remission induction; 2 were ALL and 2 were AML and they also died. Chemotherapy side effects were only recorded in the files of 12 patients and in some files it wasn’t mentioned whether they improved or not.
The treatment outcome for patients in this study showed that 19.6% were in complete remission, 42.4% still receiving chemotherapy as continuation of treatment (one patient is receiving chemotherapy after relapse), 3.8% abandoned treatment and 34.2% died. Sepsis was the leading cause of death in this study presenting (64.8%) of total deaths all over the study
The overall survival (OS), event free survival (EFS) and disease free survival (DFS) were 65.8%, 63.8% and 89.2% respectively, there were statistical significant difference between the ALL and AML regarding the OS, EFS and DFS.