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Published on: March 5, 2018
Acute lymphoblastic leukaemia under 2 years
Insights
Infants diagnosed with acute lymphoblastic leukemia (ALL) under one year old face a poor prognosis. Children aged 1-2 years have similar outcomes to older children, but with higher central nervous system relapse rates.
Area of Science:
- Pediatric Oncology
- Hematology
- Leukemia Research
Background:
- Acute lymphoblastic leukemia (ALL) is a significant childhood cancer.
- Outcomes for infants diagnosed with ALL are not well-established.
- Understanding disease presentation and natural history in young children is crucial for treatment optimization.
Purpose of the Study:
- To assess the presenting features and natural history of acute lymphoblastic leukemia in children under two years of age.
- To compare outcomes in infants and young children with older children diagnosed with ALL.
- To identify specific challenges and toxicities in treating very young ALL patients.
Main Methods:
- Retrospective analysis of 48 children diagnosed with ALL under two years of age.
- Categorization into two groups: under 1 year (Group 1) and 1-2 years (Group 2).
- Comparison with a control group of 348 children aged 2-14 years (Group 3).
Main Results:
- Children under 1 year (Group 1) showed higher rates of null-cell ALL, elevated white blood cell counts, hepatosplenomegaly, and increased central nervous system (CNS) relapse.
- Disease-free and overall survival in children aged 1-2 years (Group 2) were comparable to older children (Group 3).
- Group 2 experienced a significantly higher CNS relapse rate compared to Group 3.
- Neurological toxicity from methotrexate and radiation therapy was prevalent in children under two years.
Conclusions:
- Infants under one year with ALL have a particularly poor prognosis.
- Children aged 1-2 years have a similar prognosis to older children but require strategies to mitigate higher CNS relapse rates.
- Novel approaches to CNS prophylaxis are essential to reduce both CNS disease incidence and treatment-related toxicity in young ALL patients.
Abstract:
Presenting features and natural history were assessed in 48 children with acute lymphoblastic leukaemia less than 2 years of age at diagnosis. Of these, 16 were less than 1 year (group 1) and 32 were between 1 and 2 years (group 2). Results were compared with a group of 348 children between the ages of 2 and 14 years (group 3) diagnosed over the same period. The children in group 1 presented with a higher prevalence of null cell acute lymphoblastic leukaemia, leucocyte counts greater than 100 X 10(9)/l, and hepatosplenomegaly and had a higher central nervous system (CNS) relapse rate and shorter duration of remission than those in the other two groups. Disease free survival and overall survival in group 2 paralleled that of group 3, although children in group 2 had a significantly higher CNS relapse rate. Neurological toxicity resulting from treatment with methotrexate and radiation was common in those under 2 years as a whole. In conclusion, children under 1 year have a particularly poor prognosis, while those between 1 and 2 years have a prognosis similar to that in the older age group. Alternative approaches to CNS prophylaxis are needed to reduce the high prevalence of CNS disease and toxicity.
