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Updated: Aug 3, 2025
Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
Published on: September 18, 2013
Outcomes following induction failure in Japanese children with acute lymphoblastic leukemia
Chihaya Imai1, Atsushi Sato2, Mitsuteru Hiwatari3,4
1Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuou-Ku, Niigata City, Niigata, 951-8510, Japan. chihaya@med.niigata-u.ac.jp.
Insights
Induction failure in childhood acute lymphoblastic leukemia (ALL) affects 1.8% of patients. Poor prognostic factors include high day 15 bone marrow blast counts in B-cell precursor ALL and younger age in T-cell ALL.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Trials
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Understanding outcomes for patients with induction failure is crucial for improving treatment strategies.
Purpose of the Study:
- To investigate the characteristics and prognosis of Japanese children with ALL who experienced induction failure.
- To identify prognostic factors associated with survival in this cohort.
Main Methods:
- Retrospective analysis of data from Japanese clinical trials for newly diagnosed ALL (1996-2009).
- Inclusion of 4956 participants, with 89 (1.8%) experiencing induction failure.
- Multivariate analysis to identify significant prognostic factors.
Main Results:
- The 5-year overall survival rate for the entire cohort was 43.0%.
- Day 15 M3 marrow (≥25% blasts) was a significant predictor of poorer survival in BCP-ALL.
- Younger age (<6 years) was associated with poor survival in T-ALL, though further investigation is needed.
Conclusions:
- The induction failure rate and survival outcomes in this Japanese cohort are comparable to previous reports.
- Specific prognostic factors were identified for BCP-ALL and T-ALL, guiding future risk stratification and treatment decisions.
Abstract:
The characteristics and prognosis of Japanese children with acute lymphoblastic leukemia (ALL) who fail to achieve complete remission after remission induction chemotherapy (i.e., experience induction failure) are poorly understood. Therefore, we retrospectively analyzed data of patients enrolled in Japanese clinical trials for newly diagnosed ALL between 1996 and 2009. Among 4956 participants, 89 (1.8%) experienced induction failure. With a 6.0-year median follow-up, the 5-year overall survival rate of the entire cohort was 43.0% ± 5.5%. Survival rates did not differ between patients with B-cell precursor ALL (BCP-ALL) and T-cell ALL (T-ALL). In multivariate analysis, day 15 M3 marrow (bone marrow blast count ≥ 25%) was significantly correlated with poorer survival in the whole or BCP-ALL cohorts. In T-ALL, age < 6 years was significantly associated with poor survival. However, due to the small sample size, this correlation must be further investigated. Most T-ALL and BCR-ABL-positive BCP-ALL patients underwent allogeneic stem cell transplantation (allo-SCT). Survival rates did not differ between BCR-ABL-negative BCP-ALL patients who did and did not undergo allo-SCT, possibly due to the inclusion of lower-risk patients in the latter group. In conclusion, the induction failure rate and survival after diagnosis of induction failure in our study were comparable to previously reported figures.
