الفهرس 
Review of literature
Clinical presentationOnly 14 pages are availabe for public view
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Abstract
Acute Lymphoblastic Leukemia is a heterogeneous hematologic disease characterized by the malignant transformation and proliferation of lymphoid progenitor cells in the bone marrow, blood and extramedullary sites. The incidence rate of ALL is approximately 1.58 per 100,000 individuals per year, with slight male predominance (1.3:1). ALL accounts for approximately 1% of all adult cancers but nearly 25% of all childhood cancers being the most common malignancy in this age group.
In this work we evaluated the impact of MRD and conventional risk factors on the outcome of treatment of adult ALL patients regarding DFS, OS and CIR. Also conventional risk factors are correlated with MRD at different time points to evaluate the impact of these factors on treatment outcome.
Fifty six adult ALL patients presented to the department of clinical hematology, National Cancer Institute and Nasser institute hospital in the period from September 2014 to January 2018 were included in this study. The median age was 29.5 years and the median follow up period was 15 months.
The most commonly encountered immunophenotype was Pre B ALL (64.3%), followed by Common ALL (32.1%) and Pro B-ALL (3.6%). Cytogenetic study was done for 56 cases and revealed normal cytogenetics in 42 cases (75.0%), Philadelphia positive in 13 cases (23.2%) and t (4, 11) in 1 case (1.8%).
According to conventional risk factors at diagnosis, all cases were classified into standard risk 22 (39.3%) and high risk 34 (60.7%) then patients reclassified in each risk group into standard risk MRD-LR 12 (21.4%), standard risk MRD-HR 10 (17.9%), high risk MRD-LR 13 (23.2%), and high risk MRD-HR 21 (37.5%) according to result of MRD at D28 of induction (≤ 0.01 vs. > 0.01). Patients received either Dana Farber protocol for patients 18 to 39 years or Hoelzer protocol for patients ≥ 40 years. For high risk patients, HLA-typing was performed. If an identical donor was found; the patient was referred for allogeneic BMT.
In this study the overall complete remission rate was 78.6% (44 cases attained CR of which 1 case with salvage therapy out of total 56 cases) with a relapse rate of 38.6% (17 cases out of 44 cases) after a median follow up of 15 months.
The 2-years DFS, OS and CIR for the whole group of patients were 40%, 45.5% and 45% respectively with a median DFS of 12 months and a median OS of 15 months. The 2 years DFS and OS were 55.7% and 60.3% for the SR group while the 2 year DFS and OS were 29% and 35.5 % for HR group respectively.
MRD was done at three time points in order to determine the value of MRD monitoring by MFC in predicting outcome in terms of DFS and OS and to monitor the cumulative incidence of relapse.
MRD was done at D28 for 53 cases and revealed 28 cases (52.8%) had MRD > 0.01% (MRD HR) and 25 cases (47.2%) had MRD ≤ 0.01% (MRD LR). The CIR at 2 years was 89% for MRD HR patients and 15% for MRD LR patients. The cumulative DFS at 2 years was 85% for MRD LR patients and 5% for MRD HR patients.
MRD was done post consolidation for 44 cases, 16 cases (36.4%) had MRD ≥ 0.01% and 28 cases (63.6%) had MRD < 0.01%. The CIR at 2 years was 91.5% for patients who had detectable MRD post consolidation and 14% for patients with undetectable MRD levels. The cumulative DFS at 2 years was 6 % for patients not achieving MRD clearance post consolidation and 83.5% for patients having undetectable MRD levels.