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Acute lymphoblastic leukemia in children below two years of age
D Derulska1, R Rokicka-Milewska, Z Lewicki
1University School of Medicine, Warsaw, Poland.
Insights
Pediatric acute lymphoblastic leukemia (ALL) treatment outcomes improved with intensified therapy, but remain unsatisfactory for infants and high-risk patients. Treatment protocols significantly impact event-free survival in children with ALL.
Area of Science:
- Pediatric Oncology
- Hematology
Background:
- 11.4% of 1464 children diagnosed with acute lymphoblastic leukemia (ALL) were under two years old.
- Infants and children with high white blood cell counts (WBC ≥ 100,000/mL) or central nervous system (CNS) infiltration at diagnosis represent a high-risk group.
Purpose of the Study:
- To evaluate the impact of different treatment protocols on event-free survival (EFS) in pediatric ALL patients.
- To identify prognostic factors influencing treatment outcomes in young children with ALL.
Main Methods:
- Retrospective analysis of 167 pediatric ALL patients diagnosed under two years of age.
- Comparison of treatment outcomes between St. Jude/LSA2L2 (Group I) and BFM (Group II) protocols.
- Kaplan-Meier survival estimates to assess EFS at 8 years.
Main Results:
- Complete remission was achieved in 85% of patients.
- Event-free survival after 8 years was 19.47% for Group I and 37.38% for Group II (p=0.05).
- Relapses occurred in 63 children during treatment and 5 after cessation, with bone marrow involvement being most common.
Conclusions:
- Therapy intensification, particularly with BFM protocols, improved EFS in pediatric ALL.
- Outcomes remain suboptimal for infants and those with high initial WBC, highlighting the need for further treatment advancements.
- Age at diagnosis, initial WBC, and treatment protocol are significant prognostic factors in pediatric ALL.
Abstract:
From among 1464 children with ALL 167 (11.4%) at diagnosis had two or less than two years, 53 of them were infants. Most of them had a great tumor bulk, 15 had initial CNS infiltration and 31 WBCc greater than or equal to 100000/ML. 66 were treated according to St. Jude or LSA2L2 programs (the I group), 101 according to BFM programs (the II group). Complete remission was obtained in 85% of patients. In 63 children relapses occurred in the course of treatment whereas in 5 after the therapy cessation. In majority of cases, there were isolated relapses, mostly, they involved bone marrow. CNS involvement was found, in both mixed and isolated relapses, in 28 children (20%). 64 children are alive, in 43 of them the therapy was stopped. Kapla-Meier estimates for event free survival (EFS) after 8 years were 19 +/- 4.7% in the first group vs 37.38 +/- 6.3% in the second group. Due to therapy intensification the treatment results have been improved (p = 0.05) but still they are not satisfactory, particularly in case of infants and children with WBC greater than or equal to 100000/ML. Analysis of the lot of children showed that apart from age at ALL diagnosis and the initial WBC the methods of treatment are also the prognostic factors.