DefinePK

Abstract

Background:
The outcome for acute lymphoblastic leukemia (ALL) in the adult population as compared to pediatric population has been lower. The Medical Research Council United Kingdom (MRC UKALL) XII protocol has demonstrated promising results in adult patients but the data remains limited in the South Asian population. This study aims to evaluate treatment outcomes, complications, and survival factors that influence the overall survival.
Methods:
A retrospective cohort study was conducted at Aga Khan University, Karachi between January 2011 and December 2022. Data was collected on patients’ demographics, laboratory parameters, disease phenotype, cytogenetics, remission rates, minimal residual disease (MRD), and survival outcomes. Kaplan-Meier and Cox regression analyses were used to assess disease-free survival (DFS) and overall survival (OS), along with prognostic factors of treatment response.
Results:
The study consisted of 200 adult ALL patients, who received MRC UKALL XII regimen. Complete morphological remission was achieved in 66.5% of patients. MRD-negative patients had better long-term survival (40%) than MRD-positive (20%). At the end of follow-up period, 150 patients had died (75%) while only 50 were alive, with the most common cause of death being relapse-related mortality (65.3%). The median overall survival (OS) and median disease-free survival (DFS) were 15.35 months and 12.1 months respectively. Relapse rate was 50%, which varied by age. 
Conclusion:
Our findings offer meaningful analysis for the treatment outcome of UKALL XII protocol in adult ALL patients in Pakistan. Age, gender, MRD status, initial WBC count, and cytogenetics are some key prognostic indicators that need further investigation to improve outcomes in our region.