Summary:
Treatment of acute lymphoblastic leukaemia yields high
complete remission (CR) rate with disappointingly low overall
survival. We describe the results of induction in 22 cases of
adult acute lymphoblastic leukaemia treated between January
2011 and January 2013. Median age at presentation was 28
years (range 13-70). Fatigue (n=15, 68%) was the most
frequent presenting complaint followed by fever (n=14,
63.7%). 36.3% patients presented with splenomegaly while
31.8% had lymphadenopathy. The average presenting white
cell count was 61 k/ul. B-ALL was more common than TALL
(59% and 27% respectively). 8 cases were deemed high
risk and 14 cases were standard risk. One patient died early
in induction before specific treatment. 20 patients were treated
with intensive chemotherapy (CALGB8811=12, MCP 841=4,
CCG-BFM=2 and BFM-90=1, others 1). Overall CR was
85% while CR in CALGB8811 was 83.3%.The average time
to NADIR was 10 days (range 6 -17 days). The most common
complication in induction was neutropenic sepsis (n=19,
86.4%) contributing alone to induction mortality of 15%
(n=3). Causative organism was identified in only 31.8% cases
(n=7), the commonest being pseudomonas and coagulase
negative staphylococcus. Facilities for extended
immunophenotyping and cytogenetic tests (in addition to
BCR-ABL by PCR) are required for administration of
standard of treatment.
Key words: Acute lymphoblastic leukaemia, Induction
chemotherapy.