Research Article
Journal of Global Hematology
Volume 2, Issue 1, 2021, Pages 1-11 
10.18081/JGH/2021.2/1
Authors
Wei Zhang 1 , Liying Chen 2 , Jianhong Xu 3 * 
Affiliation
1 Department of Hematology, Shanghai Cancer Center, Fudan University, Shanghai, China.
2 Department of Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
3 Department of Hematology, Shanghai Cancer Center, Fudan University, Shanghai, China
Received 12 January 2021; revised 19 March 2021; accepted 22 March 2021; published 08 April 2021
Abstract
Background: Acute Lymphoblastic Leukemia (ALL) remains a significant health challenge in Pakistan, with the Philadelphia chromosome (Ph+) being a crucial prognostic marker. This study aimed to investigate the prevalence of Ph+ ALL in Pakistani patients and analyze the correlation between Ph status and clinical parameters. Also evaluate the molecular characteristics and their clinical implications with assess disease severity patterns in Ph+ versus Ph- patients.
Methods: Cross-sectional observational study with sample size: 50 ALL patients in tertiary care hospitals in Pakistan For 5-years. Molecular testing: Karyotyping, RT-PCR, FISH analysis. Clinical parameters: Complete blood count, bone marrow examination. Disease severity assessment: WBC count, blast percentage.
Results: Demographic findings showed that age range 19-64 years (mean: 40.14 years) and gender distribution: Balanced between males and females. Ph+ prevalence: 40% (higher than global average of 25-30%). The clinical parameters showed that: WBC count: Mean 48.78 × 10⁹/L (Ph+ patients showing higher counts), Blast percentage: Mean 70.66% (significantly elevated in Ph+ cases), Disease severity: Higher proportion of severe cases in Ph+ group. Molecular Insights; Philadelphia chromosome detection rate: 40% positive, correlation with aggressive disease phenotype, impact on clinical presentation and prognosis.
Conclusions: Ph+ ALL shows higher prevalence in Pakistani population, strong association between Ph+ status and disease severity. Age-independent distribution of Philadelphia chromosome
Keywords: Acute Lymphoblastic Leukemia, Philadelphia Chromosome, BCR-ABL1, Molecular Diagnostics, Disease Severity
1. Khorana AA. Cancer-associated thrombosis: updates and controversies. Hematology Am Soc Hematol Educ Program. 2012;2012:626-630. doi:10.1182/asheducation-2012.1.626
2. Khorana AA, Dalal M, Lin J, Connolly GC. Incidence and predictors of venous thromboembolism among ambulatory high-risk cancer patients. Cancer. 2013;119(3):648-655. doi:10.1002/cncr.27772
3. Lee AY, Peterson EA. Treatment of cancer-associated thrombosis. Blood. 2013;122(14):2310-2317. doi:10.1182/blood-2013-04-460154
4. Lee AY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349(2):146-153. doi:10.1056/NEJMoa025313
5. Weitz JI, Fredenburgh JC. Anticoagulant therapy for venous thromboembolism. Hematology Am Soc Hematol Educ Program. 2017;2017(1):576-584. doi:10.1182/asheducation-2017.1.576
6. Raskob GE, van Es N, Verhamme P, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378(7):615-624. doi:10.1056/NEJMoa1711948
7. Young AM, Marshall A, Thirlwall J, et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol. 2018;36(20):2017-2023. doi:10.1200/JCO.2018.78.8034
8. Agnelli G, Becattini C, Meyer G, et al. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med. 2020;382(17):1599-1607. doi:10.1056/NEJMoa1915103
9. Wang KL, Yap ES, Goto S, et al. The diagnosis and treatment of venous thromboembolism in Asian patients. Thromb J. 2018;16:4. doi:10.1186/s12959-018-0152-z
10. Li A, Garcia DA, Lyman GH. Venous thromboembolism in patients with cancer: optimizing prevention and treatment. Am Soc Clin Oncol Educ Book. 2019;39:147-155. doi:10.1200/EDBK_100021
11. Chan N, Sobieraj-Teague M, Eikelboom JW. Direct oral anticoagulants: evidence and unresolved issues. Lancet. 2020;396(10266):1767-1776. doi:10.1016/S0140-6736(20)32278-8
12. Streiff MB, Holmstrom B, Angelini D, et al. NCCN Guidelines Insights: Cancer-Associated Venous Thromboembolic Disease, Version 2.2018. J Natl Compr Canc Netw. 2018;16(11):1289-1303. doi:10.6004/jnccn.2018.0084
13. Young AM, Marshall A, Thirlwall J, et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: Results of a randomized trial (SELECT-D). J Clin Oncol. 2018;36(20):2017-2023. doi:10.1200/JCO.2018.78.8034
14. Raskob GE, van Es N, Verhamme P, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378(7):615-624. doi:10.1056/NEJMoa1711948
15. Khorana AA. Cancer-associated thrombosis: Updates and controversies. Hematology Am Soc Hematol Educ Program. 2012;2012:626-630. doi:10.1182/asheducation-2012.1.626
16. Farge D, Debourdeau P, Beckers M, et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost. 2013;11(1):56-70. doi:10.1111/jth.12070
17. Agnelli G, Becattini C, Meyer G, et al. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med. 2020;382(17):1599-1607. doi:10.1056/NEJMoa1915103
18. Farge D, Bounameaux H, Brenner B, et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol. 2016;17(10):e452-e466. doi:10.1016/S1470-2045(16)30369-2
19. Kraaijpoel N, Carrier M. Direct oral anticoagulants for cancer-associated venous thromboembolism: where do we stand in 2020? Curr Treat Options Oncol. 2020;21(2):13. doi:10.1007/s11864-020-0701-2
20. Yousif N. High-level of Notch1/JAG1 signaling pathway up regulated chemo-resistance of bevacizumab in colon cancer: Inducing metastasis and poor survival. Annals of Oncology, 2017.
21. Steffel J, Verhamme P, Potpara TS, et al. The 2018 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018;39(16):1330-1393. doi:10.1093/eurheartj/ehy136
22. Li A, Garcia DA, Lyman GH. Venous thromboembolism in patients with cancer: Optimizing prevention and treatment. Am Soc Clin Oncol Educ Book. 2019;39:147-155. doi:10.1200/EDBK_100021
23. Wang KL, Yap ES, Goto S, et al. The diagnosis and treatment of venous thromboembolism in Asian patients. Thromb J. 2018;16:4. doi:10.1186/s12959-018-0152-z
24. NG Yousif, LA Ahmed, AM Sadeq. The Prevalence of Anemia and Hemoglobinpathies among Students: Cross Section Study. Prensa Med Argent, 2020.
This work is licensed under a Creative Commons Attribution 4.0 International License
All articles published in The Journal of Global Hematology (JGH) are licensed under Copyright Creative Commons Attribution 4.0 International License.