Abstract
DNA ploidy is an important prognostic parameter in paediatric B-ALL, but the significance of the S-phase fraction is unclear. In present study, DNA ploidy was assessed in 40 pediatric B-ALL cases by flow cytometry. The DI (DNA index) and percentage of cells in S-phase were calculated using Modfit software. Aneuploidy was noted in 26/40 (65%) cases. A DI of 1.10-1.6 (hyperdiploidy B) was noted in 20/40 (50%) and 6/40 (15%) had a DI>1.60 (triploid and tetraploid range). Some 14/40 (35%) cases had a diploid DI between 0.90-1.05. None of the cases had a DI <0.90 (hypodiploid) or in the 1.06-1.09 (hyperdiploid A) range. The mean S-phase fraction was 2.6%, with 24/40 (60%) having low and 16/40 (40%) high S-phase fractions. No correlation was noted with standard ALL risk and treatment response factors with DI values or S-phase data, except for a positive correlation of low S-phase with high NCI risk category (p=0.032). Overall frequency of hyperdiploidy in our cohort of B-ALL patients was very high (65%). No correlation between hyperdiploidy B and low TLC or common B-phenotype was observed in our study as 42% cases with DI 1.10-1.6 had TLC> 50 x 109 and 57.1% CD 10 negativity. The study also highlighted that S-phase fraction analysis does not add any prognostic information and is not a useful parameter for assessment in ALL cases. However, larger studies with long term outcome analysis are needed to derive definitive conclusions.
Highlights
DNA ploidy was assessed in 40 pediatric B-Acute lymphoblastic leukemia (ALL) cases by flow cytometry
Acute lymphoblastic leukemia (ALL) is the most common malignancy in pediatric age group accounting for about 23% of all pediatric malignancies
The study was conducted from June 2013 to May 2014 and 40 consecutively diagnosed cases of acute lymphoblastic leukemia were enrolled during this period
Summary
Acute lymphoblastic leukemia (ALL) is the most common malignancy in pediatric age group accounting for about 23% of all pediatric malignancies. Though DNA ploidy assessment is a standard investigation in work up for ALL patients in the west, there are very few studies in the past from our subcontinent on the subject All these studies have relied upon conventional cytogenetic method to highlight the incidence of various numerical or structural abnormalities. In a study by (Somnath et al, 2011), bone marrow samples of 31 cases of pediatric ALL were assessed for chromosomal abnormalities by conventional cytogenetics They found an incidence of 51.2% (16/31) for hypodiploidy and 32.2% (10/31) for hyperdiploidy. The above studies from our region show a high incidence of the high risk hypodiploidy group in both pediatric and adult ALL cases Despite of these studies, the data on DNA ploidy frequencies in pediatric ALL population is limited. We have tried to correlate the ploidy and S-phase data
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