Changes of the Platelet Count and Red Cell Distribution Width during Induction Treatment are Predictors of Induction Failure in Pediatric Acute Lymphoblastic Leukemia

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Abstract
Background: Acute lymphoblastic leukemia (ALL) is the most common cancer during childhood. The goal of this study is to evaluate the value of different peripheral blood parameters in the prediction of induction remission in these patients. Methods: Our study included 100 children with ALL who were admitted to Shefa Al-Orman Children's Cancer Hospital between January 2022 and January 2024. Data about complete blood counts (CBC) and bone marrow parameters at days 0, 8, 19, and 42 of induction chemotherapy were collected and analyzed. Results: B-ALL cases represented 75% of cases. Ninety-four patients achieved complete remission (CR) by the end of induction. A significant decrease in both platelets (PLT) and red cell distribution width (RDW) was found to increase the likelihood of induction failure (p = 0.03 and 0.05, respectively). The ROC curve revealed that only PLT had significant discrimination ability between successful and failed induction, with an AUC of 0.64 (p = 0.03). Conclusion: We concluded that a decrease in platelet count and RDW was associated with induction failure. Long-term follow-up is needed to evaluate the effect of these parameters on disease-free survival and overall survival

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