The Relapses in Childhood Acute Lymphoplastic Leukemia Excluding L3: Experience of Single Institute/ Baghdad

Six hundred patients diagnosed with acute lymphoblastic leukemia, seventy-nine patients were excluded from study, nine patients died very early before starting induction, seventy patients referred or starting treatment in another centers.

The medical history, laboratory data had been taken for patients including age, gender, residence, date of diagnosis, date of treatment, outcome of induction period and time of relapse, investigations at time of relapse, therapy and relapse outcome were carried out through chart analysis.

The initial diagnosis of ALL was done through bone marrow aspiration morphological classification of blast cells was performed according to the FAB method while immunophenotyping not done for all patients (not available in the period from 2013 to 2016( 227 cases not diagnosed by flowcytometry,294 cases diagnosed by flowcytometry), cytogenetic study not available in our country. The initial diagnostic screen (complete blood count and blood film, renal function test and serum electrolytes and serum uric acid, liver function tests, hepatitis screen, chest x ray, echo-study, computerized tomography and MRI done for indicated cases.

Risk group of patients at time of intial diagnosis divided into standard risk group (age between 1 years and 9.9 years and initial WBC count less than50000) and high risk group (age less than 1 and more than 10 years and WBC count more than 50000 and T cell leukemia) .

Patients regarded and treated as T cell leukemia either by flow cytometry or on clinical bases (mediastinal widening) which associated with(older age,high WBC count, lymphadenopathy, hepatosplenomegaly).