The use of simple hematologic measurements predict relapse in children with acute lymphoblastic leukemia

Purpose: The identification of early relapse in children treated for acute lymphoblastic leukemia might further improve the cure rate, although no har d data in support of this prospect are available at present. Unfortunately, many of the newer approaches to this challenge are not widely available in less developed countries. We tested the hypothesis that persistent abnorma lities in simple hematologic parameters of peripheral blood, after treatmen t of ALL, may predict the subsequent recurrence of disease. Patients and Methods: Charts were reviewed from all patients in a single in stitution who were in their first continuing complete remission for at leas t 6 months after completion of therapy. Palpable splenomegaly, Hb, MCV, WBC , ANC, ALC, Platelets and MPV were recorded thereafter at consecutive 6-mon th and subsequently annual intervals. Data in the non-relapsing children we re compared to those in relapsers using Fisher's Exact Test. Additionally, the normalization times of hematologic parameters after therapy were record ed for both groups. Results: Of 104 patients, 7 relapsed. Those who had more than one abnormal parameter at 6 months after therapy were significantly more likely (p=0.02) to have a subsequent relapse than those in whom this was not the case (Spe cificity 98%, Negative Predictive Value 95%, Diagnostic Accuracy 93%). Ther e were no significant differences in the mean normalization times of the st udy variables between the non-relapsers (8 weeks) and relapsers (5 weeks). Conclusions: While results of this study are statistically significant, the frequency of the abnormalities and the interval between their discovery an d the subsequent recurrence of disease do not suggest that simple blood cou nts are clinically useful as a means of detecting relapse of ALL. A study w ith a larger sample size should be conducted.