Publication:

Clinico-epidemiological study of extramedullary disease manifestations in childhood acute lymphoblastic leukaemia in a tertiary care centre

Background Data on extramedullary manifestation of acute lymphoblastic leukemia (ALL) in Indian children are very limited, authors analyzed the clinical, epidemiological and immunophenotype profile of these manifestations in our pediatric patients.

Methods This was a prospective observational study in which data of 46 children with ALL, aged 0 to 14 years were analysed.

Results Among the total 46 patients of ALL admitted 86.95% presented with extra medullary features. Definite male preponderance (67.5%) was observed, 80% patients were aged between one to ten years. Common extra medullary features included hepatomegaly (95%), followed by splenomegaly (77%), lymphadenopathy (58%), arthritis (17.5%), and CNS involvement in 5%.  Mediastinal mass was seen in 5 %. Majority of them (67.5%) had White blood cell (WBC) count less than 20,000/mcL. 92.5% were Pre B ALL, while T ALL was seen in three (7.5%) patients. Out of these three T cell ALL two presented with mediastinal mass and one with CNS leukemia.

Conclusions The clinicians must be aware of the constellation of different extramedullary features to diagnose ALL. Early diagnosis and prompt treatment may improve the clinical outcome in these patients. Authors suggest larger multi-centric studies to understand the clinical and laboratory profile of extramedullary disease in ALL for better risk stratification to help in risk-adopted therapy.