Al-Badrani Khalid S, Al-Kzayer Lika'a Fasih Y, Ali Kenan Hussien, Khaleel Asmaa M A, Fadhil Nashwan Ahmed, Alsammak Bassam Negem A, Al-Agele Yasir S, Malallah Abduladheem H, Abdullah Dana Ahmed, Hamza Hiwa Hassan, Kamata Minoru
Department of Hematopathology, Ibn Al-Atheer Hospital for Children, Mosul, Iraq.
Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Transl Pediatr. 2025 May 30;14(5):900-914. doi: 10.21037/tp-2025-24. Epub 2025 May 23.
Flow cytometry (FCM) is a powerful tool for classifying acute leukemia (AL) to acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) and further subtyping. Accurate diagnosis of AL improves the outcome. Mosul, a city in Iraq, had no FCM laboratory yet, mainly due to repeated wars in the area. The Japan Chernobyl Foundation (JCF), a Japanese non-profit humanitarian organization, helped establish the first FCM Laboratory in Mosul. We aimed to evaluate the project from a scholarly point of view with a focus on childhood ALL.
An observational study was done after JCF provided the BD FACSCanto II system and all related materials. Anonymous data of the patients, including age, sex, address, initial complete blood count (CBC) with bone marrow aspirate (BMA) results, and coded FCM reports, were prospectively collected from February 2021 to January 2024. In addition to clinical notes on pediatric ALL cases, their treatment, and outcomes with a median follow-up of 26.2 (range, 0-44.3) months.
Childhood ALL cases were 76, including (60, 78.9%) B-lineage ALL (B-ALL) and (16, 21.1%) T-lineage ALL (T-ALL) cases. B-ALL cases were classified as pro-B, common-B, pre-B, and mature-B, with frequencies of 11.7%, 76.7%, 10.0%, and 1.6%, respectively. T-ALL included early T-cell precursor (ETP), pro-T, pre-T, cortical-T, and medullary-T, with frequencies of 6.25%, 18.75%, 18.75%, 31.25%, and 25.00%, respectively. Furthermore, 20 pediatric AML cases were identified and sub-typed. Among ALL cases, the male-to-female ratio (M/F) was 1.5. There were 24 (31.6%) cases with white blood cell (WBC) counts of ≥50×10/L and 29 (38.2%) who were aged ≥10 years or ≤12 months. There was a substantial association between high WBC and male sex with the T-ALL subtype. Based on clinical criteria and immunophenotyping of ALL, 47 (61.8%) of patients were identified as a high-risk (HR) group, while 29 (38.2%) were of standard-risk (SR) group. Relapses were reported in 8 (11.6%) patients with ALL, principally in the HR group. The induction mortality rate was 4.2%. Septic death was the leading cause of death (8/17, 47.1%), especially in those younger than 2 years old. The overall survival (OS) in ALL cases was 73.7%. The OS and event-free survival (EFS) for the SR group of ALL were 86.2% and 82.8%, respectively.
JCF's role was crucial in providing Mosul City, Iraq, with the first FCM Unit. The project made a breakthrough in AL diagnosis and established one of the important and supposed routine steps represented by ALL immunophenotyping. The HR group represented a significantly large portion of our ALL cases. Although the outcome was satisfactory for the SR group, the survival rate for the HR group was dismal. Further efforts are needed to scale up diagnostic and therapeutic capabilities to improve the outcome of ALL in Mosul City.
流式细胞术（FCM）是一种强大的工具，可用于将急性白血病（AL）分类为急性淋巴细胞白血病（ALL）或急性髓细胞白血病（AML），并进一步进行亚型分类。准确诊断AL可改善治疗结果。伊拉克城市摩苏尔尚未建立FCM实验室，主要原因是该地区战乱不断。日本非营利性人道主义组织日本切尔诺贝利基金会（JCF）帮助在摩苏尔建立了首个FCM实验室。我们旨在从学术角度评估该项目，重点关注儿童ALL。
在JCF提供BD FACSCanto II系统及所有相关材料后开展了一项观察性研究。从2021年2月至2024年1月前瞻性收集患者的匿名数据，包括年龄、性别、地址、初始全血细胞计数（CBC）及骨髓穿刺（BMA）结果，以及编码后的FCM报告。除了儿科ALL病例的临床记录外，还记录了他们的治疗情况及中位随访26.2（范围0 - 44.3）个月后的结局。
儿童ALL病例共76例，其中B系ALL（B - ALL）60例（78.9%），T系ALL（T - ALL）16例（21.1%）。B - ALL病例分为前B细胞型、普通B细胞型、前B细胞型和成熟B细胞型，频率分别为11.7%、76.7%、10.0%和1.6%。T - ALL包括早期T细胞前体（ETP）、前T细胞型、前T细胞型、皮质T细胞型和髓质T细胞型，频率分别为6.25%、18.75%、18.75%、31.25%和25.00%。此外，还识别并分型了20例儿科AML病例。在ALL病例中，男女比例（M/F）为1.5。有24例（31.6%）白细胞（WBC）计数≥50×10⁹/L，29例（约38.2%）年龄≥10岁或≤12个月。高WBC与男性性别与T - ALL亚型之间存在显著关联。根据ALL的临床标准和免疫表型分析，47例（61.8%）患者被确定为高危（HR）组，而29例（38.2%）为标准风险（SR）组。ALL患者中有8例（11.6%）复发，主要在HR组。诱导死亡率为4.2%。败血症死亡是主要死因（8/17，47.1%），尤其是2岁以下患者。ALL病例的总生存率（OS）为73.7%。ALL的SR组的OS和无事件生存率（EFS）分别为86.2%和82.8%。
JCF在为伊拉克摩苏尔市提供首个FCM设备方面发挥了关键作用。该项目在AL诊断方面取得了突破，并确立了ALL免疫表型分析这一重要且应常规开展的步骤之一。HR组在我们的ALL病例中占比显著。尽管SR组的结果令人满意，但HR组的生存率却很惨淡。需要进一步努力扩大诊断和治疗能力，以改善摩苏尔市ALL的治疗结果。
