DNA Ploidy and S-phase Fraction Analysis in Paediatric B-cell Acute Lymphoblastic Leukemia Cases: a Tertiary Care Centre Experience

  • Kumar, Banothu Kiran (Department of Pediatrics, All India Institute of Medical Sciences) ;
  • Bhatia, Prateek (Pediatric Hemato-Oncology Unit, Department of Paediatrics, Post Graduate Institute of Medical Education and Research (PGIMER)) ;
  • Trehan, Amita (Pediatric Hemato-Oncology Unit, Department of Paediatrics, Post Graduate Institute of Medical Education and Research (PGIMER)) ;
  • Singh, Ajit Pal (Pediatric Hemato-Oncology Unit, Department of Paediatrics, Post Graduate Institute of Medical Education and Research (PGIMER)) ;
  • Kaul, Deepak (Pediatric Hemato-Oncology Unit, Department of Paediatrics, Post Graduate Institute of Medical Education and Research (PGIMER)) ;
  • Bansal, Deepak (Pediatric Hemato-Oncology Unit, Department of Paediatrics, Post Graduate Institute of Medical Education and Research (PGIMER))
  • Published : 2015.12.03


DNA ploidy is an important prognostic parameter in paediatric B-ALL, but the significance of the S-phase fraction is unclear. In present study, DNA ploidy was assessed in 40 pediatric B-ALL cases by flow cytometry. The DI (DNA index) and percentage of cells in S-phase were calculated using Modfit software. Aneuploidy was noted in 26/40 (65%) cases. A DI of 1.10-1.6 (hyperdiploidy B) was noted in 20/40 (50%) and 6/40 (15%) had a DI>1.60 (triploid and tetraploid range). Some 14/40 (35%) cases had a diploid DI between 0.90-1.05. None of the cases had a DI <0.90 (hypodiploid) or in the 1.06-1.09 (hyperdiploid A) range. The mean S-phase fraction was 2.6%, with 24/40 (60%) having low and 16/40 (40%) high S-phase fractions. No correlation was noted with standard ALL risk and treatment response factors with DI values or S-phase data, except for a positive correlation of low S-phase with high NCI risk category (p=0.032). Overall frequency of hyperdiploidy in our cohort of B-ALL patients was very high (65%). No correlation between hyperdiploidy B and low TLC or common B-phenotype was observed in our study as 42% cases with DI 1.10-1.6 had TLC> $50{\times}10^9$ and 57.1% CD 10 negativity. The study also highlighted that S-phase fraction analysis does not add any prognostic information and is not a useful parameter for assessment in ALL cases. However, larger studies with long term outcome analysis are needed to derive definitive conclusions.


ALL;DNA-index;ploidy;S-phase fraction;paediatric leukemia cases


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