Clinicohematological profile and immunophenotypic patterns of childhood acute leukemia: Prognostic correlation

Acute leukemia (AL) presents a heterogeneous molecular profile, requiring precise diagnostic categorization and subcategorization. The present study aims to estimate the clinicohematological profile and immunophenotypic pattern of childhood AL while conducting prognostic assessments. This cross-sectional study analyzed a total of 68 samples of AL collected from January 2019 to June 2021. The male-to-female ratio was 4.6:1, with a mean age of 6.6 3.4 years. Total leukocyte count (TLC) was significantly increased in all types of AL (P = 0.03). The median value (interquartile range) of TLC (106/dL) was 8,450 (4,100 27,950), with blast counts in peripheral smears at 59 (24 80), and in bone marrow aspirates (BMAs) at 95 (75 98). There was a significant association (P < 0.001) and a strong association (C = 0.9110) between the morphology of BMA with immunophenotype. Based on immunophenotype, AL was categorized into four groups: B-cell acute lymphoblastic leukemia (B-ALL) (51.5%), T-cell acute lymphoblastic leukemia (T-ALL) (10.3%), AML (22%), and mixed phenotype AL (MPAL) (16.2%). Furthermore, eight subgroups were identified: B lineage, Ia-Common-B-ALL (88.6%) and Ib-Pre-B-ALL (11.4%); T-lineage, IIa-Cortical T-ALL (71.4%) and IIb-Pre-T-ALL (28.6%); AML subgroups, IIIa-M2 (73.93%) and III-M4 (26.7%); and MPAL subgroups, IVa-aberrant expression of myeloid antigens in B-ALL (90.9%), and IVb-aberrant expression of lymphoid markers in AML (9.1%). A poor prognostic immunophenotype (T-ALL, AML) was significantly (P = 0.023) more prevalent in deceased patients with AL. The highest mortality rate was observed in AML (86.4%), followed by T-ALL (57.2%). The most common immunophenotype observed was Common-B-ALL in childhood AL, and a poor prognostic immunophenotype (T-ALL and AML) with the highest mortality rate was found in AML. Thus, knowledge about clinicohematological and immunophenotypic patterns will aid in patient management.