Early Steroid Response in Pediatric ALL Patients and Relation to Immunocytochemical Expression of cCD79a and cCD3 A Clinico-Pathological Study

Abstract

ABSTRACT

Background: Pediatric acute lymphoblastic leukemia (ALL) is a heterogeneous disease in which many genetic lesions result in multiple biologic subtypes. Leukaemic blast cell immunophenotype is an important biologic factor with prognostic value, as well as, the early prednisone response which has evolved as one of the strongest prognostic factors.

Objective: To evaluate early steroid response in pediatric ALL patients and its association with immunocytochemical expression of cCD79a and cCD3

Methods: The study was conducted from April 2011 to March 2013, including 60 newly diagnosed children with ALL from the Central Child Teaching Hospital, Baghdad, Iraq. Each patient was assessed twice, the first assessment was at time of admission, and the second was after a 7 day prednisone course (40 mg/m2). In the first assessment, 2 bone marrow aspirate (BMA) smears for immunocytochemical (ICC) staining for cCD79a and cCD3 were obtained, and in the second assessment patients were classified as prednisone-good responders (< 1000/µL PB blasts) or prednisone-poor responders (≥ 1000/µL PB blasts)

1000/µL PB blasts).  Results: Out of total 60 BMA smears, 41(68%) were cCD79a positive and cCD3 negative and thus considered B-ALL subtype, and 13 (22%) were cCD79a negative and cCD3 positive, classified as T-ALL subtype. Fifty two patients (87%) were good steroid responders and 8 (13%) were poor steroid responders. Thirty four out of 41 B-ALL (82.9%) and 12/13 T-ALL (92.3%) patients showed good steroid response (p > 0.05).

Conclusions: The majority of children (87%) with ALL were good steroid responders. There was no significant difference in steroid response between patients with B-ALL or TALL subtypes.