Outcomes Of Infant Acute Lymphoblastic Leukaemia; An Experience From Low Middle Income Country

Background: Acute Lymphoblastic Leukaemia (ALL) is the most common pediatric malignancy. This study was done to describe the prognostic factors and course of infant ALL in Pakistan. Methods: This retrospective observational study was performed at the department of Paediatric Oncology/Haematology, CMH Hospital Rawalpindi, Pakistan, from January 2012 to December 2023. Data of infants with confirmed diagnosis of ALL by immunophenotyping and treated as per Interfant 06 protocol were analyzed. Non-probability consecutive sampling technique was adopted. Disease risk stratification was done based on clinical and laboratory markers. Prognostic factors, overall survival (OS), and disease-free survival (DFS) were documented. Statistical analysis was performed using IBM-SPSS Statistics, Version 26.0. Results: In a total of 47 infants, there were 25 (53.2%) male, and the median age was 9.00 (6.00-10.00) months. Age (p<0.001), and MLL rearrangement (p<0.001) had significant association with disease risk group. During the evaluation period, relapse was noted among 17 (36.2%) cases. Mortality was reported among 33 (70.2%) cases. The median DFS, and OS were 6.90 (1.90-27.3) months, and 9.6 (2.90-29.0) months, respectively. ALL disease risk categorization was found to have significant association with overall survival (p=0.016). Evaluation of laboratory parameters revealed that mortality was significantly associated with higher leukocytes count (p=0.027), and lower platelets count (p=0.010). Conclusion: The overall mortality in ALL is high. These findings highlight the critical role of risk group stratification, elevated WBC count, and low platelet count in predicting survival outcomes in infant ALL.