Childhood Leukemias in Khyber Pakhtunkhwa and Afghan Children Visiting to Hayatabad Medical Complex Hospital

Background: Khyber Pakhtoonkhwa and Afghanistan located in South Central Asia which is most prevalent area for childhood leukemia. In this region, no previous data or study was available on estimated cases per year of different types of childhood leukemia. The aim of the present study is to evaluate the frequency of different types of childhood leukemia in the children from different districts of Khyber Pakhtoonkhwa (KP) and Afghanistan presenting to Hayat Abad Medical Complex Hospital, Peshawar. Methods: This descriptive cross-sectional study was conducted in pathology department Hayat Abad Medical Complex hospital, Peshawar, Pakistan. Duration of the present study was, from January 2014 to December 2016. A total number of 605 children were enrolled up to 15 years of age, who were suspected to have leukemia, went through bone marrow examination. 3 ml blood was collected in EDTA tube (purple top) and complete blood count was prepared by hematology analyzer (Ruby cell dyne, Abbott, USA). By aseptic techniques bone marrow aspiration and bone marrow trephine biopsy samples were collected from all patients. Slides were papered from Bone marrow aspirates, fixed with methanol and stained with Giemsa, myeloperoxidase and periodic acid Schiff stain. Trephine biopsy slides were stained by Hematoxylene and Eosin and Reticulin stain. Immunohistochemistry was done after initially examining bone marrow aspirate slides. All data was documented and statistical analysis was performed by SPSS-20 software. Findings: Among 605 children suspected to have leukemia, 281 (46.5%) children were diagnosed with different types of childhood leukemia. Out of 281 diagnosed patients, 231(82.2%) were Pakistani children and rest of the 50 (17.8%) were Afghani children. The studied population consist of 173(61.6%) males and 108(38.4) females. Their age ranged from 3 months to 15 years with median age of 9.8 years. Out of 281 cases, 210 (74.73%) were diagnosed to have acute lymphoblastic leukemia and rest of the children were 62 (22.06%) acute myeloid leukemia, 7 (2.44%) chronic myeloid leukemia, 2 (0.71%) had Juvenile Chronic Myelomonocytic Leukemia (JMML) and 1 (0.35%) child was report with Chronic Myelomonocytic leukemia (CMML). There was no significant differences seen in prevalence among Afghan children and Pakistani children except ALL, which is more frequent in Afghan children compared to Pakistani children and no single case of CMML, were diagnosed in Afghan children. Conclusion: In the present study, acute lymphoblastic leukemia is most frequent leukemia in the children of Khyber Pakhtoonkhwa and Afghanistan. Juvenile chronic Myelomonocytic leukemia is found the less common leukemia in the present study.