Evaluation of peripheral blood count recovery as predictors of clinical outcome during induction chemotherapy in childhood acute lymphoblastic leukemia

Background
Accurate monitoring of bone marrow recovery after induction chemotherapy in pediatric with acute lymphoblastic leukemia (ALL) is crucial. Reticulocyte parameters may predict hematopoietic regeneration earlier than platelet and neutrophil counts, but data in Egyptian children are lacking.


Objectives
To investigate the potential role of different hematopoietic parameters in predicting recovery in postchemotherapy ALL pediatric Egyptian patients.


Patients and methods

This prospective cohort investigation enrolled 80 children (aged 18 or younger) with B- or T-cell ALL commencing induction chemotherapy. Peripheral blood samples were drawn at 4-day intervals over a maximum of 32 days. Key metrics included reticulocyte percentage, absolute reticulocyte count, absolute neutrophil count, and platelet count, with “recovery” established as three consecutive days above predetermined levels. Statistical comparisons of recovery durations were performed using nonparametric ANOVA (significance set at
P
<0.05).



Results

All measured recovery durations exhibited statistically significant differences (
P
=0.015 for reticulocyte percentage,
P
=0.003 for absolute reticulocyte count,
P
=0.001 for platelets, and
P
=0.002 for absolute neutrophil count). Importantly, after a median follow-up of 30 months, the 3-year event-free survival stood at 75.0%, and overall survival at 85.0%, with median event-free survival and overall survival yet to be reached. Factors such as poor Day 8’s steroid response and older age consistently predicted poorer outcomes.



Conclusion
For Egyptian children with ALL undergoing chemotherapy, reticulocyte measurements demonstrate a significantly earlier return to normal compared with platelet counts, positioning them as valuable, rapid indicators of bone marrow recovery. Furthermore, poor early steroid response and older age are critical prognostic markers influencing long-term survival.