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The immunophenotype in infant acute lymphoblastic leukaemia: correlation with clinical outcome. An Italian
G Basso1, M C Putti, A Cantú-Rajnoldi
1Department of Pediatrics, University of Padova, Italy.
Insights
Immunophenotype analysis in infant acute lymphoblastic leukemia (ALL) reveals that CD10-negative and myeloid antigen-positive ALL are associated with poorer outcomes. These findings highlight the importance of immunological markers for risk stratification and treatment selection in pediatric leukemia.
Area of Science:
- Pediatric Hematology Oncology
- Immunology
- Leukemia Research
Background:
- Infant acute lymphoblastic leukemia (ALL) presents unique challenges in diagnosis and treatment.
- Understanding the immunophenotypic landscape of infant ALL is crucial for prognostic assessment.
Purpose of the Study:
- To analyze the immunophenotype of 112 infants under 18 months with ALL.
- To correlate immunophenotypic subtypes with clinical outcomes, specifically event-free survival (EFS).
Main Methods:
- Detailed immunophenotyping of 112 infant ALL cases.
- Stratification of patients into age groups (under 6, 6-12, 13-18 months).
- Statistical analysis of event-free survival (EFS) based on immunophenotypic markers like CD10 and myeloid antigens (MyAg).
Main Results:
- Common ALL (CD10-positive) and pre-B ALL were frequent subtypes.
- Immature phenotypes (pre-pre-B ALL, AUL) and anomalous markers (MyAg, CD7) were more prevalent in younger infants.
- CD10-positive ALL showed significantly better EFS (48%) compared to CD10-negative ALL (25%).
- MyAg-negative ALL also demonstrated superior EFS compared to MyAg-positive ALL.
- CD10-negative, MyAg-positive ALL, more frequent in infants, had a poorer outcome.
Conclusions:
- Immunophenotypic analysis is vital for prognostic evaluation in infant ALL.
- CD10 negativity and MyAg positivity identify high-risk infant ALL phenotypes.
- These findings support tailoring therapeutic strategies based on immunological markers for improved outcomes in infant leukemia.
Abstract:
A detailed analysis of immunophenotype of 112 infants aged less than 18 months with acute lymphoblastic leukaemia (ALL) was performed. Patients were divided into three groups on the basis of age at presentation (under 6 months: group 1: 6-12 months: group 2; 13-18 months: group 3). There were three cases of T-ALL (2.6%). The proportion of other subtypes was: common ALL in 59 patients (52.68%), pre-B ALL in 15 patients (13.3%), pre-pre-B ALL in 27 (24.1%) and acute undifferentiated leukaemia (AUL) in eight patients (7.14%). In non-T ALL, positivity to CD10 (corresponding to C-ALL and pre-B ALL) was distributed in the three age groups as follows: 38.88% (group I) 65.38% (group II) and 86.36% (group III). Conversely, immature phenotypes (pre-pre-B and AUL) were found more often in the younger patients of groups I and II, as well as anomalous phenotypes, such as the presence of myeloid antigens (MyAg) and of CD7. Prognostic significance was evaluated as event-free survival (EFS) by statistical analysis. A better outcome in CD10-positive ALL than in CD10-negative ones (48% v. 25% of long-term survivors) was demonstrated in all infants. Similarly, EFS was significantly better in MyAg-negative than in MyAg-positive cases. These results were confirmed also when adjusting for white blood cell count. This allowed the identification of CD10-negative, MyAg-positive ALL, which were relatively more frequent in infants and had a poorer clinical outcome with the current therapies. This study stresses the prognostic relevance of the immunological study in infant leukaemias and its utility in choosing different therapeutic modalities for poor risk phenotypes.