Exploring the Relationship between CD66c Expression and Clinico-Haematological Parameters in Pediatric B-Cell Acute Lymphoblastic Leukemia (ALL)

Background: Pediatric B-cell Acute Lymphoblastic Leukemia presents with diverse clinical and hematological manifestations. Understanding these characteristics is crucial for effective management and prognostication.  Methods: This study conducted as prospective observational study at Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, from November 2017 to March 2019. This study enrolled 30 pediatric patients with B-cell ALL who underwent comprehensive evaluations including routine and specialized hematological tests, bone marrow aspiration (BMA), cytochemistry, and immunophenotyping. Clinical features, hematological parameters, and CD66c expression on lymphoblasts were assessed.  Results: Immunophenotyping revealed that 28 cases (93.3%) were CALLA positive (CD10 positive), while 2 cases (6.7%) were CALLA negative (CD10 negative). The age ranged from 1.5 to 12 years, with a 2:1 male to female ratio. The mean age was 4.8 years.. Common presenting complaints included fever (93.3%) and pallor (60.0%). Hepato-splenomegaly (60.0%) and lymphadenopathy (60.0%) were the most frequent clinical findings. Hematological findings showed moderate to severe anemia (mean hemoglobin 7.19 g/dL), with 56.7% of patients having hemoglobin levels between 4.0-7.9 g/dL. Leukocytosis (>10,000/cumm) was observed in 53.3% of cases, with 20% having total leukocyte counts >50,000/cumm. Thrombocytopenia (platelet count ≤ 25,000/cumm) was noted in 56.7% of patients. Immunophenotyping revealed CD66c expression >20% gated in 46.7% of cases, correlating with more severe clinical features and poorer hematological parameters.  Conclusion: Pediatric B-cell ALL exhibits a spectrum of clinical and hematological features. Elevated CD66c expression correlates with aggressive disease presentation and worse clinical outcomes, suggesting its potential utility as a prognostic marker. Early identification of these parameters can aid in risk stratification and tailored therapeutic approaches.