Usman M, Burney I, Nasim A, Adil S N, Salam A, Siddiqui T, Khurshid M.
Outcome of Adult Acute Lymphoblastic Leukemia: a single center experience.
J Pak Med Assoc Jan ;53(9):384-8.

Objective: To study the outcomes of adult patients with acute lymphoblastic leukemia. Setting: Tertiary care hospital. Study Design: Retrospective analysis. Methods: Fifty eight adult patients (age >14years) diagnosed as cases of acute lymphoblastic leukemia were studied with respect to their clinical, morphological and immunopathological features at presentation and their relationship with treatment outcomes. Results: Forty five (77.5%) of the patients belonged to younger age group with male preponderance. The median age was 20 years and mean age was 25.1 years. Male to female ratio was 3:1. Common presenting signs were lymphadenopathy (17.2%), hepatomegaly (32.7%) and splenomegaly (62%). Laboratory features at presentation revealed: hemoglobin >=10gm/dl in 18 (31%), WBC >50 x 10E9 / L in 18 (31%), LDH more than 1000 IU/L in 44 (75.8%) of patients. Morphology revealed that FAB L1 was seen in 21(37.2%) and L2 in 62 (32.7%). Immunophenotyping showed that 26 (61.9%) were early pre-B ALL, 6 (14.2%) were pre - B ALL and T-ALL were 10 (23.8%). Univariate analysis showed age more than 30 years, male gender, total leucocyte count >50x10e9/L and hemoglobin more than 10gm/dl to be risk factors for poor outcome. Multivariate analysis revealed age more than 30 years, male sex and total leucocyte count > 50 x 109/L are independent risk factors for poor survival. Patients were treated according to the MRCUKX and XII adult protocols. Thirteen (22.4%) patients died during induction therapy secondary to sepsis and progressive disease whereas 42(72.4%) patients achieved complete remission. Median survival was 18.6 months and 42% patients were alive at 5-years. Conclusion: Overall survival and disease free survival were comparable to those reported in literature. However, age more than 30 years, male gender and total leucocyte count >50 x 10 9 /L had an adverse impact on overall survival (JPMA 53:384;2003).

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