Institutional Study of Acute Lymphoblastic Leukemia in Children at BSMMU a Tertiary Level Hospital in Bangladesh

Introduction: Acute lymphoblastic leukemia (ALL) is the most common malignancy among children worldwide. Due to advancements in diagnostic technology and improved treatment, the survival rate in high-income countries is above 90%. However, the survival rate in low and middle-income countries ranges from 22% to 79%.

Methods: A retrospective study was done on demographic, biological, and clinical parameters of children under 18 years of age with newly diagnosed ALL presenting between 2021-2023 in pediatric hematology and oncology centers of BSMMU in Bangladesh.

Results: ALL 220 patients were analyzed. Among them, 80% ALL B-cell (176) and 20% ALL T-cell (n= 44). The median age was 5.5 years (IQR 7.29). At diagnosis, 76% of patients were categorized as standard risk and 34% as high risk, and they received the UK ALL-2019 interim guideline. MRD was done in 92% of patients. Central nervous system (CNS) involvement was evaluated at diagnosis. CNS-1 was 95% (n=195), CNS-2 was 4.4% (n=14), CNS-3 was 0.7% (n=11), and 1.9% (n=8) had cranial nerve palsy. Chemotherapy delays >2 weeks were reported in 82.0% (n=180) of patients. Delays were due to infection in 53.2% (n=161), drug-related toxicities in 26.8% (n=59), and resource constraints in 20%(n=44).

Conclusion: This work reveals a data analysis of ALL and how to improve survival rates, including severe infections, treatment interruptions, drug modification, and how to serve as the new standard of care for pediatric ALL patients.

Keywords: ALL- Acute Lymphoblastic Leukemia, LMIC-Low-and Middle-Income Countries, LIC-Low-Income Countries, CNS-Central Nervous System, MRD-Minimal Residual Disease.