Diagnostic profile of Pediatric T-Lymphoblastic Leukemia and its correlation with post-induction disease status

Abstract

Objective: To determine the diagnostic profile of T-ALL in pediatric patients and correlate the association of the clinical characteristics with early disease outcome determined through minimal/measurable residual disease (MRD) status, tested after the induction phase of chemotherapy at day-35.

Methodology: This retrospective cohort study was conducted at the Hematology Department of Indus Hospital and Health Network, Karachi, (IHHN) from October 2023 to December 2024 including 75 newly diagnosed T-ALL patients aged 1-16 years, who presented to our facility and were under treatment in Pediatric Oncology services.

Results: Median age of patients was 9.52 years, with male to female ratio of 4:1. Most frequent presenting complaint was fever 92%. Mediastinal mass was present at 34.7% and CNS involvement in 4%. Immunophenotypic profile showed aberrant CD13 and CD79a expression in 1.3%. Following early treatment, 81.3% were steroid good responders; 1.3% expired before day 8, 2.7% expired before day=35. After induction of chemotherapy, 92% achieved morphological remission whereas 74.6% were MRD negative.

Conclusion: In LMICs like Pakistan, pediatric T-ALL patients usually presents with advanced disease. However, risk stratification employing clinical features and early treatment outcome leading to intensified multi-agent chemotherapy administration ultimately achieved disease remission in majority of the patients, similar in comparison to local and international data.