title: Pattern of relapse in paediatric acute lymphoblastic leukaemia in a tertiary care unit.
abstract: OBJECTIVE
  To determine the frequency, site and time to relapse from diagnosis, and to see the relationship of relapse with important prognostic factors.
  
  
  METHODS
  The prospective descriptive observational study was conducted at the National Institute of Child Health, Karachi, June 2005 to May 2007, and comprised newly-diagnosed cases of acute lymphoblastic leukaemia. Bone marrow aspiration was done on reappearance of blast cells in peripheral smear and cerebrospinal fluid. Detailed report was done each time when intra-thecal chemotherapy was given or there were signs and symptoms suggestive of central nervous system relapse. SPSS 12 was used for data analysis.
  
  
  RESULTS
  Of the 60 patients enrolled, 4(6.6%) expired and 1(1.7%) was lost to follow-up. Of the 55(91.6%) who comprised the study sample, 35(58%) were males and 25(42%) females. Mean age of relapse was 6.8±3.27 years. Mean time to relapse from diagnosis was 1.3±0.54 years; 12(20%) patients suffered relapse, and of them 5(14%) were boys. Central nervous system relapse in 8(67%) patients was the most common site, with 3(25%) bone-marrow relapses. Out of 12 patient with relapses, 9(75%) had white blood cell count less than 50,000/cm.
  
  
  CONCLUSIONS
  Relapse in acute lymphoblastic leukaemia was common, although treatment modalities are improving day by day.
authors.affiliation: Department of Emergency Medicine, Karachi.
authors.forename: Emad Uddin
authors.initials: EU
authors.lastname: Siddiqui
authors.affiliation: Department of Emergency Medicine, Karachi.
authors.forename: Sayyeda Ghazala
authors.initials: SG
authors.lastname: Kazi
authors.affiliation: National Institute of Child Health, Karachi.
authors.forename: Muhammad Irfan
authors.initials: MI
authors.lastname: Habib
authors.affiliation: National Institute of Child Health, Karachi.
authors.forename: Khalid Mehmood
authors.initials: KM
authors.lastname: Ahmed Khan
authors.affiliation: Senior Instructor Research, Aga Khan University Hospital, Karachi.
authors.forename: Nukhba
authors.initials: N
authors.lastname: Zia
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D019046:Bone Marrow Neoplasms / Q000453:epidemiology*; D016543:Central Nervous System Neoplasms / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D010154:Pakistan / Q000453:epidemiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011379:Prognosis; D011446:Prospective Studies; D012737:Sex Factors; D062606:Tertiary Care Centers
keywords: Acute lymphoblastic leukaemia, Blast cells, Bone marrow, Relapse.