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Updated: Sep 27, 2026
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
Prognostic factors and outcome for children after second central nervous system relapse of acute lymphoblastic
Emma C Morris1, Georgina Harrison, Clifford C Bailey
1Department of Haematology, Great Ormond Street Hospital for Children, London, UK.
Insights
Survival after central nervous system (CNS) relapse in childhood acute lymphoblastic leukaemia (ALL) is poor. Isolated CNS relapse and longer time to relapse improve outcomes, but palliative care is often appropriate after second CNS relapse.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Trials
Background:
- Childhood acute lymphoblastic leukaemia (ALL) remains a significant challenge, particularly concerning central nervous system (CNS) involvement.
- Relapse, especially with CNS disease, portends a poor prognosis in pediatric ALL patients.
Purpose of the Study:
- To analyze survival outcomes and identify prognostic factors for children experiencing CNS involvement in their first two relapses of ALL.
- To evaluate the effectiveness of treatment strategies and guide therapeutic decisions for recurrent CNS ALL.
Main Methods:
- Retrospective analysis of data from the Medical Research Council UKALL X and XI trials (1985-1997).
- Inclusion criteria: 3,702 children with ALL, focusing on the 79 with CNS involvement in the first two relapses.
- Statistical analysis to determine factors predicting survival from second relapse.
Main Results:
- Only 14 out of 79 children (17.7%) survived following second relapse with CNS involvement.
- Survival rates were significantly better for isolated CNS relapse compared to combined CNS involvement (P = 0.02).
- Longer time from diagnosis to second CNS relapse was a significant predictor of improved survival (P = 0.004).
Conclusions:
- Prognosis after a second CNS relapse in childhood ALL is extremely poor.
- Treatment strategies should consider the site of relapse (isolated CNS vs. combined) and the time to relapse.
- Palliative therapy should be considered an appropriate management option for patients with poor prognostic indicators after second CNS relapse.
Abstract:
The Medical Research Council acute lymphoblastic leukaemia trials (UKALL X and XI) recruited 3,702 children with ALL between January 1985 and March 1997. Seventy-nine children had central nervous system (CNS) involvement in their first two relapses. Fourteen children survived at a median follow-up of 22 months from second relapse; seven (9%) in third remission, two in later remissions and five with disease. Factors predictive of survival from second relapse were site (isolated CNS was better than combined CNS, P = 0.02) and time from diagnosis to second CNS relapse (longer time was better, P = 0.004). Prognosis after second CNS relapse is extremely poor, and palliative therapy is appropriate.
