Outcomes after induction failure in childhood acute lymphoblastic leukemia.
BACKGROUND: Failure of remission-induction therapy is a rare but highly adverse event in children and adolescents with acute lymphoblastic leukemia (ALL). METHODS: We identified induction failure, defined by the persistence of leukemic blasts in blood, bone marrow, or any extramedullary site after 4...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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2012
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| _version_ | 1797098393678381056 |
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| author | Schrappe, M Hunger, S Pui, C Saha, V Gaynon, P Baruchel, A Conter, V Otten, J Ohara, A Versluys, AB Escherich, G Heyman, M Silverman, L Horibe, K Mann, G Camitta, B Harbott, J Riehm, H Richards, S Devidas, M Zimmermann, M |
| author_facet | Schrappe, M Hunger, S Pui, C Saha, V Gaynon, P Baruchel, A Conter, V Otten, J Ohara, A Versluys, AB Escherich, G Heyman, M Silverman, L Horibe, K Mann, G Camitta, B Harbott, J Riehm, H Richards, S Devidas, M Zimmermann, M |
| author_sort | Schrappe, M |
| collection | OXFORD |
| description | BACKGROUND: Failure of remission-induction therapy is a rare but highly adverse event in children and adolescents with acute lymphoblastic leukemia (ALL). METHODS: We identified induction failure, defined by the persistence of leukemic blasts in blood, bone marrow, or any extramedullary site after 4 to 6 weeks of remission-induction therapy, in 1041 of 44,017 patients (2.4%) 0 to 18 years of age with newly diagnosed ALL who were treated by a total of 14 cooperative study groups between 1985 and 2000. We analyzed the relationships among disease characteristics, treatments administered, and outcomes in these patients. RESULTS: Patients with induction failure frequently presented with high-risk features, including older age, high leukocyte count, leukemia with a T-cell phenotype, the Philadelphia chromosome, and 11q23 rearrangement. With a median follow-up period of 8.3 years (range, 1.5 to 22.1), the 10-year survival rate (±SE) was estimated at only 32±1%. An age of 10 years or older, T-cell leukemia, the presence of an 11q23 rearrangement, and 25% or more blasts in the bone marrow at the end of induction therapy were associated with a particularly poor outcome. High hyperdiploidy (a modal chromosome number >50) and an age of 1 to 5 years were associated with a favorable outcome in patients with precursor B-cell leukemia. Allogeneic stem-cell transplantation from matched, related donors was associated with improved outcomes in T-cell leukemia. Children younger than 6 years of age with precursor B-cell leukemia and no adverse genetic features had a 10-year survival rate of 72±5% when treated with chemotherapy only. CONCLUSIONS: Pediatric ALL with induction failure is highly heterogeneous. Patients who have T-cell leukemia appear to have a better outcome with allogeneic stem-cell transplantation than with chemotherapy, whereas patients who have precursor B-cell leukemia without other adverse features appear to have a better outcome with chemotherapy. (Funded by Deutsche Krebshilfe and others.). |
| first_indexed | 2024-03-07T05:08:53Z |
| format | Journal article |
| id | oxford-uuid:dae00194-c47d-4486-8278-d9a5b052abdf |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:08:53Z |
| publishDate | 2012 |
| record_format | dspace |
| spelling | oxford-uuid:dae00194-c47d-4486-8278-d9a5b052abdf2022-03-27T09:06:24ZOutcomes after induction failure in childhood acute lymphoblastic leukemia.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:dae00194-c47d-4486-8278-d9a5b052abdfEnglishSymplectic Elements at Oxford2012Schrappe, MHunger, SPui, CSaha, VGaynon, PBaruchel, AConter, VOtten, JOhara, AVersluys, ABEscherich, GHeyman, MSilverman, LHoribe, KMann, GCamitta, BHarbott, JRiehm, HRichards, SDevidas, MZimmermann, MBACKGROUND: Failure of remission-induction therapy is a rare but highly adverse event in children and adolescents with acute lymphoblastic leukemia (ALL). METHODS: We identified induction failure, defined by the persistence of leukemic blasts in blood, bone marrow, or any extramedullary site after 4 to 6 weeks of remission-induction therapy, in 1041 of 44,017 patients (2.4%) 0 to 18 years of age with newly diagnosed ALL who were treated by a total of 14 cooperative study groups between 1985 and 2000. We analyzed the relationships among disease characteristics, treatments administered, and outcomes in these patients. RESULTS: Patients with induction failure frequently presented with high-risk features, including older age, high leukocyte count, leukemia with a T-cell phenotype, the Philadelphia chromosome, and 11q23 rearrangement. With a median follow-up period of 8.3 years (range, 1.5 to 22.1), the 10-year survival rate (±SE) was estimated at only 32±1%. An age of 10 years or older, T-cell leukemia, the presence of an 11q23 rearrangement, and 25% or more blasts in the bone marrow at the end of induction therapy were associated with a particularly poor outcome. High hyperdiploidy (a modal chromosome number >50) and an age of 1 to 5 years were associated with a favorable outcome in patients with precursor B-cell leukemia. Allogeneic stem-cell transplantation from matched, related donors was associated with improved outcomes in T-cell leukemia. Children younger than 6 years of age with precursor B-cell leukemia and no adverse genetic features had a 10-year survival rate of 72±5% when treated with chemotherapy only. CONCLUSIONS: Pediatric ALL with induction failure is highly heterogeneous. Patients who have T-cell leukemia appear to have a better outcome with allogeneic stem-cell transplantation than with chemotherapy, whereas patients who have precursor B-cell leukemia without other adverse features appear to have a better outcome with chemotherapy. (Funded by Deutsche Krebshilfe and others.). |
| spellingShingle | Schrappe, M Hunger, S Pui, C Saha, V Gaynon, P Baruchel, A Conter, V Otten, J Ohara, A Versluys, AB Escherich, G Heyman, M Silverman, L Horibe, K Mann, G Camitta, B Harbott, J Riehm, H Richards, S Devidas, M Zimmermann, M Outcomes after induction failure in childhood acute lymphoblastic leukemia. |
| title | Outcomes after induction failure in childhood acute lymphoblastic leukemia. |
| title_full | Outcomes after induction failure in childhood acute lymphoblastic leukemia. |
| title_fullStr | Outcomes after induction failure in childhood acute lymphoblastic leukemia. |
| title_full_unstemmed | Outcomes after induction failure in childhood acute lymphoblastic leukemia. |
| title_short | Outcomes after induction failure in childhood acute lymphoblastic leukemia. |
| title_sort | outcomes after induction failure in childhood acute lymphoblastic leukemia |
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