Retrospecti̇ve evaluati̇on of pedi̇atri̇c pati̇ents di̇agnosed wi̇th acute leukemi̇a, wi̇th presenti̇ng symptoms, physi̇cal exami̇nati̇on fi̇ndi̇ngs and di̇agnosi̇s laboratory results

Objective: This study aims to determine the first presentation complaints, physical examination findings and clinical manifestations of childhood leukemia cases and shorten the time between the first presentation and leukemia diagnosis. At the same time, with the epidemiological data to be obtained on leukemia, it aims to raise awareness, especially about pediatric leukemias. Materials and Methods: This study was carried out in a group of pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) by applying to the Uludağ University Faculty of Medicine Pediatric Hematology Polyclinic between 01.01.2010 - 31.12.2020. The files of 359 patients aged 0-18 years were reviewed retrospectively, and their leukemia subtype, age at diagnosis, sex, duration of diagnosis, initial complaints, physical examination findings, complete blood counts at the time of diagnosis, uric acid-lactate dehydrogenase (LDH) parameters, and cytogenetic analyzes were evaluated. In addition, parameters affecting the time from the first complaint to the diagnosis, relapse and mortality were determined. Results: Of the 292 ALL and 67 AML patients included in our study, 143 (39.8%) were girls and 216 (60.2%) were boys, the mean age at diagnosis was 4.8 years for ALL, 12.1 years for AML. From the onset of their complaints to diagnosis, the median time was 14 days. It was observed that ALL patients were diagnosed with L1 at most with 86.6% according to the French-American-British (FAB) classification. 25.4% of AML patients were diagnosed with M2 at most according to immunophenotype and pathological classification. The mean hemoglobin value of patients with ALL at the time of diagnosis is 8.51 g/dl, median platelet value is 57150 10⁹/l, median leukocyte value is 14450 10⁹/l, the uric acid median value is 4.65 mg/dl, and median LDH value is 560 U/ lt was detected. In patients with AML, the mean hemoglobin value at the time of diagnosis is 8.89 g/dl, median platelet value is 58000 10⁹/l, median leukocyte value is 9850 10⁹/l, the median uric acid value is 4.2 mg/dl, and median LDH value is 544 U/ lt was found. The most common chromosomal anomaly was del(9p21) in ALL, while t(15;17) was in AML. The most common complaint at presentation was fever (42.62%), and the physical examination finding was splenomegaly (43.18%). All admission complaints and physical examination findings were systematically evaluated in detail. The relapse rate was 11% in ALL, 19.4% in AML; stem cell transplantation rate was 13% in ALL, 26.9% in AML; the overall mortality rate was 19.2% in ALL and 29.9% in AML. In addition, it was observed that the median time to diagnosis was longer in patients with infiltrative complaints and musculoskeletal complaints at the time of admission. When evaluated with the multivariate analysis method, the risk of relapse was found to be higher in patients with AML and patients with a high tumor burden at the time of diagnosis. For mortality, leukocyte levels≥50,000 at the time of diagnosis and relapse were determined as risk-increasing factors. Conclusion: In our study, it was found that most of the patients diagnosed and treated in our clinic were patients with acute lymphoblastic leukemia, most frequently with fever-fatigue complaints and more regularly with organomegaly on physical examination. It is seen that the most important factor affecting survival in both leukemia groups is the high leukocyte count at the time of diagnosis and the relapse observed.