Patient characteristics
Over a period of three years, we included 110 patients with ALL in the study. The patient characteristics are shown in table 3. The median age at diagnosis was 4.8 years, 23 patients (20.9 %) were older than 10 years and 2 patients (1.8 %) were infants under 1 year. The male to female ratio was 1.39, with 64 male patients (58.2 %) and 46 female patients (41.8 %). A higher male to female ratio was also reported for a large cohort in Southeast Asia 8 and by the European BFM Study group 9.
The median white blood cell (WBC) count at diagnosis was 40.65 x 109/l (interquartile range (IQR), 10 – 105.95 x 109/l). Fifty-three patients (48.2 %) initially had a WBC count of more than 50 x 109/l, from the latter, 29 patients (26.4 %) suffered from hyperleukocytosis with a WBC count over 100 x 109/l, which is more than two fold more frequent than in European patient populations 9 and in a large South Asian cohort 8. This supports the clinical impression that patients present late at the hospital with a high disease burden. Consistently, the majority of patients, 63 (57.3 %) was stratified into the HR group, mostly based on the high leukemia burden, whereas 47 patients (42.7 %) were allocated to the SR group.
The major extramedullary disease manifestations were liver and spleen enlargement in 80.9 % of patients and nodal involvement in 57.3%. 104 patients (94.5 %) were anemic at the time of diagnosis (hemoglobin (HGB < 11 g/dl), the median HGB was 7.5 g/dl. CNS involvement was detected in 3 patients (2.7%), which is within the expected range.