Outcome of Adult Acute Lymphoblastic Leukemia: A Single Center Experience

Objective: To study the outcomes of adult patients with acute lymphoblastic leukemia. Setting: Tertiary care hospital. Study Design: Retrospective analysis. Methods: Fifty eight adult patients (age >14years) diagnosed as cases of acute lymphoblastic leukemia were studied with respect to their clinical, morphological and immunopathological features at presentation and their relationship with treatment outcomes. Results: Forty five (77.5%) of the patients belonged to younger age group with male preponderance. The median age was 20 years and mean age was 25.1 years. Male to female ratio was 3:1. Common presenting signs were lymphadenopathy (17.2%), hepatomegaly (32.7%) and splenomegaly (62%). Laboratory features at presentation revealed: hemoglobin ≥10gm/dl in 18 (31%), WBC >50 × 10E9/L in 18 (31%), LDH more than 1000 IU/L in 44 (75.8%) of patients. Morphology revealed that FAB L1 was seen in 21 (37.2%) and L2 in 62 (32.7%). Immunophenotyping showed that 26 (61.9%) were early pre-B ALL, 6 (14.2%) were pre - B ALL and T-ALL were 10 (23.8%). Univariate analysis showed age more than 30 years, male gender, total leucocyte count >50×10⁹/L and hemoglobin more than 10gm/dl to be risk factors for poor outcome. Multivariate analysis revealed age more than 30 years, male sex and total leucocyte count > 50 × 10⁹/L are independent risk factors for poor survival. Patients were treated according to the MRCUKX and XII adult protocols. Thirteen (22.4%) patients died during induction therapy secondary to sepsis and progressive disease whereas 42(72.4%) patients achieved complete remission. Median survival was 18.6 months and 42% patients were alive at 5-years. Conclusion: Overall survival and disease free survival were comparable to those reported in literature. However, age more than 30 years, male gender and total leucocyte count >50 × 10 9/L had an adverse impact on overall survival.