Apoptotic cell identification: An in-vivo study during induction treatment of childhood acute lymphoblastic leukemia

Background Acute lymphoblastic leukemia (ALL) in children has high cure rate but it can cause death due to the side effects of treatment or to the disease itself. Thus the evaluation on response of treatment is important and may predict the prognosis. Since apoptosis can be induced by chemotherapy, it is thought that the number of leukemic cells that undergo apoptosis may reflect drug sensitivity and cytoreduction rate, thus it may correlate with prognosis. Objective To detect apoptotic cells in peripheral blood of children with ALL during the first week of treatment. Methods We conducted a cross sectional study on 58 children with newly diagnosed ALL treated in Department of Child Health, Sardjito Hospital, Yogyakarta. Apoptotic cells were detected on smears of buffy coat made from peripheral blod and stained with May-Grunwald Giemsa. The apoptotic cells viewed under light microscope within 12 time points during 7 days after treatment started. Results Apoptotic cells were identified in 3 of 58 patients with index range of 4.2% to 36.2%. Conclusion Apoptotic cells can be detected in peripheral blood with simple method. The explanation of why not all blood smears viewed showed these cells need further study. It may due to the methods or the apoptotic process itself.