Journal of Blood Disorders & Transfusion

Pattern of Adulthood Hematological Malignancies in Khyber Pakhtunkhwa

Khan S^1*, Mir A², Khattak BR³, Khan SN⁴, Iqbal K³ and Malik SN^{3 1}Department of Pathology Laboratory, Hayatabad Medical Complex Hospital (HMC), Peshawar, Pakistan
²Rehman Medical Institute (RMI), Peshawar, Pakistan
³Hayatabad Medical Complex Hospital, Peshawar, Pakistan
⁴Department Medical Technology, University of Haripur, Huripur, Pakistan
^*Correspondence: Khan S, Department of Pathology Laboratory, Hayatabad Medical Complex Hospital (HMC), Peshawar, Pakistan, Tel: +913339118335, Email:

Received: 30-Sep-2018 Published: 09-May-2019

Introduction

Hematological malignancies constitute a heterogeneous group of malignant disorders including leukemias, myelomas and lymphomas [1]. These conditions emerge in cells of the bone marrow and the lymphatic system which ascertain such disorders as the main seed behind the morbidity and mortality in different regions of the world. International comparative data analysis revealed geographical diversity in the prevalence of hematological malignancies, with the highest rates being found in economically developed regions and the lowest rates in areas of Africa and South Asia which may be a result of underdiagnosis and lack of registration facilities in developing countries [2].

Hematological malignancies are common, comprising approximately of 6.5% of all cancers worldwide [3]. It is the fourth most frequently diagnosed cancer in both men and women in developed countries of the world [4]. These are significantly more common in adults than in children [5].

A hematological malignancy is broadly divided into two groups according to their cell lineage as myeloid and lymphoid. The common subgroups in lymphoid neoplasms are Lymphomas including Hodgkin and Non-hodgkin’s lymphoma, Multiple Myeloma, Waldenstrom macroglobulinemia, Chronic Lymphocytic Leukemia and Acute Lymphocytic Leukemia. Myeloid neoplasms are mainly represented by Myeloproliferative Neoplasm, Myelodysplastic Syndrome and Acute Myeloid Leukemia [6,7].

Recent data showed that Non-hodgkin’s lymphoma is the most common diagnostic group of adulthood malignancy and accounts for 2.7% of all cancers worldwide followed by leukemia 2.5%, Multiple Myeloma 0.8% and Hodgkin lymphoma 0.5% of all cancers. Globally 2.4% of all deaths from cancer occurred from Non-hodgkin’s lymphoma, 3.2% from leukemia, 0.1% from Multiple Myeloma and 0.5% from Hodgkin lymphoma [3].

The prevalence of adult Hematological malignancies varies from one country to another. In developing countries lymphoma and leukemia are the most frequent and this has been reported in different studies [8]. Results of one of the study conducted at Nigeria revealed prevalence of different hematological malignancies among different age groups.They concluded that the prevalence of Acute Myeloid Leukemia, Non Hodgkin Lymphoma and Hodgkin Lymphoma was highest in patients among 21-40years of age. Chronic Myeloid leukemia, Chronic Lymphocytic Leukemia and Multiple Myeloma were common among 41-60years of age. Myelofibrosis was seen among those between 61-80years of age [5].

Another study conducted in Eastern Morocco by Elidrissi Errahhali et al showed that Non Hodgkin Lymphoma was the most prevalent hematological malignancy (29.7% of all Hematological Malignancies), followed by Hodgkin Lymphoma, Myeloproliferative Neoplasm, Multiple Myeloma, Chronic Lymphocytic Leukemia, Acute Myeloid Leukemia, Myelodysplastic Syndrom, Acute Lymphocytic Leukemia, and Waldenstrom macroglobulinemia. Majority of these cases were observed among patients of ≥ 60 years (40.4%) [6]. A study done by Hossain et al in Bangladesh showed Acute Myeloid Leukemia was most common comprising 28.3% (median age 35 years) followed by Chronic myeloid Leukemia 18.2%, Non Hodgkin Lymphoma 16.9%, Acute Lymphocytic Leukemia 14.1%, Multiple Myeloma 10.5%, Myelodysplastic Syndrom 4.5%, Hodgkin Lymphoma 3.9% with median ages of 40, 48, 27, 55, 57 and 36years respectively. The least common was Chronic Lymphocytic Leukemia 3.7% with median age of 60 years [9].

The reason for conduction of this study is to determine the frequency/pattern of different adulthood hematological malignancies from different districts of Khyber Pakhtunkhwa–Pakistan and to drag the attention of concerned to wield the fatal conditions leading to unending massacre of human lives.

Materials and Methods

It was a descriptive observational study conducted at hematology department, Rehman Medical Institute (RMI) and Pathology Department Hayatabad Medical Complex, Peshawar Pakistan. The study duration was from Dec, 2014 to Dec, 2017. In the present study a total of 571 adult patients who suspected to have Hematological malignancies were included in the study. All those patients who are previously diagnosed or currently on treatment were excluded.

All patients who visited to Rehman Medical Institute and these were examined in the clinics and bone marrow examination test was advised to all suspected patients. Two milliliter of peripheral blood was collected in K3 EDTA vacutainer tube (BD, USA) from all patients, to perform complete blood count (XN-1000, Sysmex, Japan), retic count and peripheral film examination. Bone marrow aspiration and trephine biopsy samples were taken from all patients in an aseptic environment in bone marrow sample collection room. Bone marrow aspiration and trephine biopsy slides were examined under microscope (CX22LED, Olympus, Japan) and further immunohistochemistry and Flowcytometry (Cytoflex, Beckman coulter, USA) were applied for final diagnosis.

The patient data and diagnosis were recorded in Microsoft Excel 2010 and analyzed in SPSS-22 by descriptive statistics for frequencies. Analyzed data was presented in tables.

Results

A total of 259 adult patients were diagnosed with different types of hematological malignancies among 571 suspected patients. Out of total, 186 (71.8%) were male and 73 (28.2%) were female. Adulthood Hematological malignancies is more common in male then female with ratio of 2.5:1. The age ranges of studied population were from 18 to 84 years with average age of 46.21 years. Out of 259 adult patients, 96 (37.1%) were diagnosed with myeloid hematological malignancies and 163 (62.9%) were diagnosed with lymphoid hematological malignancies. Acute Myeloid Leukemia (AML=22.3%), Acute Lymphoblastic Leukemia (ALL=21.6%) and Chronic Lymphocytic Leukemia (CLL=18.9%) were more prevalent hematological malignancies in this region while Plasma Cell Leukemia (PCL), Polycythemia Rubra Vera (PV) and Hairy Cell Leukemia (HCL) were least common hematological malignancies were found in adult suspected patients. The frequencies of other hematological malignancies were Lymphoma (10.4%), Multiple Myeloma (MM=9.7%), Chronic Myeloid Leukemia (CML=7.3%), Primary Myelofibrosis (MF=2.7%), Myelodysplastic Syndromes (MDS=2.7%) and Essential Thrombocythemia (ET=1.1%) in total hematological malignancies as shown in Table 1.

Table 1: Pattern of Adulthood Hematological Malignancies in Khyber Pakhtunkhwa Pakistan.

Discussion

The present study was conducted at Khyber Pakhtunkhwa where hematological malignancies are common and non-existence of national malignancies registry and no previous data or study are available on pattern of adulthood hematological malignancies [10]. There are geographic and racial differences in the epidemiology of adulthood hematological malignancies in the globe [11]. Childhood hematological malignancies were most prevalent in south central Asia and least common in southern Africa while adulthood hematological malignancies are most frequently found in economically developed regions and the lowest rates in areas of Africa and South Asia [12,13].

The present study was carried out to determine the pattern of adulthood hematological malignancies in Khyber Pakhtunkhwa. This study result revealed that adulthood hematological malignancies were more common in male comparatively female with ratio of 2.5:1. This result is almost similar with result of Smith et al. study [4].

In current study Acute Myeloid Leukemia (22.3%), Acute Lymphoblastic Leukemia (21.6%) and Chronic Lymphocytic Leukemia (18.9%) were found predominant adulthood hematological malignancies followed by Lymphoma (10.4%), Multiple Myeloma (9.7%), Chronic Myeloid Leukemia (7.3%), Primary Myelofibrosis (2.7%), Myelodysplastic Syndromes (2.7%), Polycythemia Rubra Vera, (2.1%), Essential Thrombocythemia (1.1%), Hairy Cell Leukemia (0.9%), Plasma Cell Leukemia (0.4%). This study result is relatively different from Hossain et al. (2014) in Bangladesh result revealed that Acute Myeloid Leukemia was most common comprising 28.3% followed by Chronic myeloid Leukemia 18.2%, Non Hodgkin Lymphoma 16.9%, Acute Lymphocytic Leukemia 14.1%, Multiple Myeloma 10.5%, Myelodysplastic Syndrom 4.5% and Hodgkin Lymphoma 3.9% [9].

The frequency of Polycythemia Rubra Vera is 2.1% which is lower in present study which compares to previous study conducted in Pakistan (Shaikh Zayed Hospital, Lahore) by Ammar and Aziz revealed that frequency of PV is 8.0% [14]. It is to keep in mind that the frequency of Polycythemia Rubra Vera in this study is only evaluated in those suspected adult patients of Myeloproliferative Neoplasm in which bone marrow examination were indicated or advised. In more hospital setups in this region, Polycythemia Rubra Vera patients are diagnosed with molecular diagnosis (PCR for JAK-2 mutation, CALR and MPL) without bone marrow examination as per WHO criteria [15].

Conclusion

Hematological malignancies are common in this part of the world, with lymphoid malignancies being more common than myeloid malignancies, and no age or gender is exempted. Acute lymphoblastic leukemia and chronic lymphocytic leukemia is most common in adulthood lymphoid hematological malignancies while hairy cell leukemia and plasma cell leukemia is rare in Khyber Pakhtunkhwa region. Present study also concluded that adulthood hematological malignancies are common in male compare to female with ratio of 2.5:1.

Conflict of Interest

There are no conflicts of interest to disclose from author.

REFERENCES

1. Hassan M, Abedi-Valugerdi M. Hematologic malignancies in elderly patients. Haematologica 2014;99:1124-1127.
2. Shirley MH, Sayeed S, Barnes I, Finlayson A, Ali R. Incidence of haematological malignancies by ethnic group in England, 2001–7. Br J Haematol. 2013;163:465-477.
3. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359-E386.
4. Smith A, Howell D, Patmore R, Jack A, Roman E. Incidence of haematological malignancy by sub-type: A report from the Haematological Malignancy Research Network. Br J Cancer 2011;105:1684.
5. Nwannadi IA, Alao O, Bazuaye GN, Halim NKD, Omoti CE. The epidemiology of haematological malignancies at the University Of Benin Teaching Hospital: A Ten-year retrospective study. Inter J Epidemiol. 2010;9:72.
6. Elidrissi Errahhali M, Elidrissi Errahhali M, Boulouiz R, Ouarzane M, Bellaoui M. Distribution and features of hematological malignancies in Eastern Morocco: a retrospective multicenter study over 5 years. BMC Cancer. 2016;16:159.
7. Morton LM, Turner JJ, Cerhan JR, Linet MS, Treseler PA, Clarke CA, et al. Proposed classification of lymphoid neoplasms for epidemiologic research from the pathology working group of the international lymphoma epidemiology consortium (InterLymph). Blood. 2007;110:695-708.
8. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87-108.
9. Hossain MS, Iqbal MS, Khan MA, Rabbani MG, Khatun H, Munira S, et al. Diagnosed hematological malignancies in Bangladesh-A retrospective analysis of over 5000 cases from 10 specialized hospitals. BMC Cancer. 2014;14:438.
10. Khan S, Mir A, Khattak BR, Rehman A. Childhood leukemias in khyber pakhtoonkhwa and afghan children visiting to Hayat Abad Medical Complex Hospital. Arch Can Res. 2017;5:149.
11. Müller AM, Ihorst G, Mertelsmann R, Engelhardt M. Epidemiology of non-Hodgkin’s lymphoma (NHL): Trends, geographic distribution, and etiology. Ann Hematol. 2005;84:1-12.
12. Magrath I, Steliarova-Foucher E, Epelman S, Ribeiro RC, Harif M, Li CK, et al.Paediatric cancer in low-income and middle-income countries.Lancet Oncol. 2013;14:e104-e116.
13. Steliarova-Foucher E, Colombet M, Ries LAG, Moreno F, Dolya A, Bray F, et al. International incidence of childhood cancer, 2001–10: A population-based registry study.Lancet Oncol. 2017;18:719-731.
14. Ammar T, Aziz M Demographic features of chronic myeloproliferative neoplasms presenting at Shaikh Zayed Medical Complex, Lahore. Biomedica 2017;33:169.
15. Tefferi A, Barbui T. Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management. Am J Hematol. 2015;90:162-173.