A RETROSPECTIVE ANALYSIS OF PATIENTS DIAGNOSED WITH ACUTE LYMPHOBLASTIC LEUKEMIA OVER FOUR CONSECUTIVE YEARS AT THE UNIVERSITY CLINIC FOR HEMATOLOGY, SKOPJE, NORTH MACEDONIA

Abstract

Aim: To analyze the molecular prognostic markers in patients diagnosed with ALL .

Material and methods: This retrospective study included newly diagnosed ALL patients treated at our centre between 2018 and 2022. Clinical, demographic, molecular, and treatment data were collected and analyzed. Outcomes included in-hospital mortality, remission rates, eligibility for allogeneic stem cell transplantation, transplantation outcomes, and overall survival. Survival analyses were performed according to initial molecular risk stratification.

Results: A total of 61 patients were diagnosed with ALL during the study period, with a median age at diagnosis of 42.9 years. B-cell ALL was identified in 38 patients (62.3%), T-cell ALL in 18 patients (29.5%), and biphenotypic leukemia in 5 patients (8.2%). Extramedullary disease was present at diagnosis in 9 patients (14.8%). High-risk disease was identified in 23 patients (37.7%). The most frequently used first-line therapy was the Hyper-CVAD protocol, administered to 41 patients (67%). Molecular analysis revealed BCR-ABL positivity in 10 patients (16.4%). Other detected abnormalities included RUNX1 mutation, NOTCH1 mutation and complex cytogenetic abnormalities. Allogeneic stem cell transplantation was performed in 12 patients (19.7%). Median overall survival was 17.5 months (data available for 58 patients). At last follow-up, 15 patients (25.9%) were alive.

Conclusion: Patients classified within the favorable ELN risk group demonstrated significantly longer survival compared to those with unfavorable molecular profiles. The observed rates of primary resistance and early mortality were consistent with published ELN data. These findings underscore the critical role of molecular diagnostics in guiding prognosis and therapeutic decision-making in ALL.