Early bone marrow response in acute lymphoblastic leukemia

Background: Evolution of risk-adapted therapies has improved our ability to treat Acute lymphoblastic leukemia. This study was planned to evaluate prognostic factors for disease remission, including age, gender, leukocyte count and blasts percentage at presentation, immunophenotype and early bone marrow response. Methods: Thirty-seven newly diagnosed cases of Acute Lymphoblastic Leukemia, aged 14 years and above were recruited for the study. The patients were diagnosed based on cytological and immunophenotypic criteria. Results were analyzed using the chi-square test and Fisher’s exact test. RESULTS: The mean age at diagnosis was 32.48±14.39 years and females were predominant (56.76%). The most common presenting features were fever and generalized weakness. The most frequently observed clinical signs were pallor and organomegaly. B-ALL was more common (78.38%) than T-ALL. The most common CD markers expressed were CD34, CD19 & CD79a in B-ALL and CD5 & CD34 in T-ALL. The remission induction rate was 70.27%. Conclusion: The prognostic factors observed are compatible with literature. It was observed that persistence of lymphoblasts in day 7 Bone marrow examination is prognostically significant. M1 Bone marrow response at day 7 is a strong predictor of prolonged complete remission and good clinical outcome as compared to M2 and M3 Bone marrow response. Addition of this clinical characteristic to the usual prognostic factors in ALL could better discriminate patients, especially among those initially thought to have a relatively favourable outcome.