The Probable Suspect in the Prediction of Relapse in Acute Leukemia: Thrombocytopenia

Abstract

Objective: Relapse is not common in patients with acute leukemia in childhood, however it is a serious complication with high mortality rate . We aimed to predict relapse among pediatric acute leukemia patients in remission by using complete blood parameters which are used routinely in clinical practice. Materials and Methods : The data of 279 children diagnosed with acute leukemia in our clinic over a 20-year period were retrospectively reviewed. Fourty two children relapsed and 37 children non-relapsed acute leukemia cases, all of whose data were available, were included in the study. Blood count parameters and physical examination findings at the time of diagnosis and during the follow-up were evaluated retrospectively in all patients. Mann-Whitney U and T-test were used for comparison of numerical variables. Chi-square test was used to compare categorical variables. Results: In the relapse group; twenty-four children were diagnosed with B-cell ALL, 10 children with T-cell ALL, and eight children with AML. In non-relapse group; 26 children had B-cell ALL, 10 children were diagnosed with T-cell and one child had AML. Thrombocytopenia was observed in 24 patients for the relapse group, compared to nine children in non-relapse group. After remission, the risk of relapse was significantly higher in patients with thrombocytopenia than in patients without thrombocytopenia among both groups. During the remission period, relapse was observed in all patients with thrombocytopenia lasting for an average of 3.86 weeks. Conclusion: Thrombocytopenia during the remission period of pediatric acute leukemia patients can be explained primarily by the effect of chemotherapeutic drugs used in treatment and possible infections on the bone marrow. We demonstrated that the presence of thrombocytopenia which develops after the remission period and lasts longer than three weeks can be used as an easy-to-access blood parameter in the prediction of relapse.