CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA - FEATURES AT THE ONSET IN PATIENTS IN MONZA (ITALY) AND MANAGUA (NICARAGUA)

Purpose: To evaluate features at diagnosis of childhood acute lymphobl astic leukemia (ALL) in different areas of developed and low-income co untries. Design: All consecutive children with ALL diagnosed in the pe riod 1988 to 1994 in Managua (Nicaragua) and Monza (Italy), which are, respectively, low-income and developed areas, have been investigated for sex distribution, hepatomegaly, splenomegaly, white blood cell (WB C) count, French-American-British (FAB) morphology, age distribution a nd immunophenotype. Results: No statistical significant differences ha ve been found for sex distribution, WBC count and immunophenotype. Of 207 Nicaraguan patients, 35% were 2 to 5 and 28% were 210 years old, w hereas in the 268 Monza patients, these percentages were 51 and 19%, r espectively. FAB L2 morphology, hepatomegaly and to a lesser extent sp lenomegaly, were more frequent in Managua patients. Conclusion: These data suggest that in Nicaragua the incidence of cALLA-positive patient s is superimposable to that of developed countries; there is, however, a clear trend for a higher frequency of older age patients, which in turn may explain the higher frequency of patients with FAB L2 morpholo gy and hepatosplenomegaly. The typical 2- 5-year-old age peak observed in developed countries is definitely less evident in Nicaragua. Epide miologic, immunophenotyping and molecular biology studies on unselecte d populations of different geographical areas should be carried out to expand our knowledge of the biologic aspects of childhood ALL worldwi de.