Challenges in Managing Adult Acute Lymphoblastic Leukaemia: A Case Series from a Resource-constrained Environment

Abstract

Background: Acute lymphoblastic leukaemia (ALL) is a clonal haematological malignancy characterized by the rapid proliferation of lymphoblasts which mostly affects children however, it also occurs in adults. The pathogenesis of ALL is multifactorial involving genetic and environmental components. The clinical presentation includes anaemia, fever, bleeding and organomegaly. Diagnosis requires ≥20% lymphoblasts in the peripheral blood and / or bone marrow. Immunophenotyping, cytogenetics and molecular assays are important to determine specific mutations involved. Definitive treatments include chemotherapy, targeted therapy, haematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy.  This study aimed to report the few cases of adult ALL encountered in our practice over a ten-year probationary period. Methods: This was a retrospective observational study. The case files of all patients aged ≥18 years of age diagnosed with ALL, either by peripheral blood or bone marrow findings, within the period of January 2014 to December 2024. Overall survival was calculated using the Kaplan-Meier curve.  Case Presentation: The median age was 30 years, with a male to female ratio of 8.3:1. Lymphadenopathy and splenomegaly were present in 66.7% and 50% cases respectively. The mean haemoglobin concentration (HB) was 6.9 (±2.4) g/dL, median WBC 27.8 X 109/L (range 1.24 – 153.8 X 109/L), mean platelet 51.0 (±33.8) X109/L. Average peripheral and bone marrow blast counts were 59.2% and 74.8% respectively. FAB subtype L3 was the commonest subtype. Immunophenotyping was done for only 2 patients who were the only patients who received chemotherapy. The median duration of treatment was 10 days (range 1 – 186 days) with a median survival of 6.9 days. Conclusion: This was a retrospective case series which showcased the multifaceted challenges in the diagnosis and management of adult ALL within resource-limited settings in the areas of clinical presentations, laboratory investigations, treatment options and outcomes.