Survival of Children with Acute Lymphoblastic Leukemia with Risk Group-Based Protocol Changes: A Single-Center
Na Hee Lee1, Hee Young Ju2, Eun Sang Yi3
1Department of Pediatrics, Cha Bundang Medical Center, Cha University, Seongnam, Korea.
Insights
Pediatric acute lymphoblastic leukemia (ALL) survival rates have significantly improved. Further research is needed for adolescent patients and those with relapsed disease.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Risk stratification is crucial for modern pediatric acute lymphoblastic leukemia (ALL) treatment.
- Understanding long-term survival and prognostic factors is essential for improving patient outcomes.
Purpose of the Study:
- To evaluate survival rates and identify prognostic factors in pediatric ALL patients over a 20-year period.
- To assess the impact of evolving treatment protocols on patient outcomes.
Main Methods:
- Analysis of 460 pediatric ALL patients treated at Samsung Medical Center (SMC).
- Patients were stratified into standard-risk (SR), high-risk (HR), and very high-risk (VHR) groups.
- HR group treatment protocols were updated during the study (2000-2019).
Main Results:
- Overall 10-year survival rate (OS) was 83.8%.
- Survival rates varied by risk group: SR (95.9%), HR (83.8%), VHR (66.2%).
- Improved OS observed in the HR group with updated protocols, particularly the 1501 protocol (96.2% 5-year OS).
Conclusions:
- Treatment outcomes for pediatric ALL have markedly improved.
- Further characterization of adolescent/young adult patients and those with relapsed disease is necessary.
- Continued refinement of risk-stratified treatment protocols is vital.
Purpose:
Recent treatments for pediatric acute lymphoblastic leukemia (ALL) are founded on risk stratification. We examined the survival rates and prognostic factors of patients over a 20-year period at a single institution.
Materials And Methods:
This study analyzed patients diagnosed with ALL and treated at the Pediatric Department of Samsung Medical Center (SMC). Patients were categorized into standard-risk (SR), high-risk (HR), and very high-risk (VHR) groups. The SMC protocol for the HR group underwent two changes during the study period: a modified Children's Cancer Group (CCG)-1882 protocol was used from 2000 to 2005, the Korean multicenter HR ALL-0601 protocol from 2006 to 2014, and the Korean multicenter HR ALL-1501 protocol from 2015 to 2019.
Results:
Of the 460 patients, complete remission was achieved in 436 patients (94.8%). The 10-year overall survival rate (OS) was 83.8±1.9% for all patients. OS according to the SMC risk group was as follows: 95.9%±1.4% in the SR group, 83.8%±3.6% in the HR group, and 66.2%±6.9% in the VHR group. The 5-year OS within the HR group varied according to the treatment protocol: 73.9%±7.5%, in the modified CCG-1882 protocol, 83.0%±3.9%, in the 0601 protocol, and 96.2%±2.6%, in the 1501 protocol. For those aged 15 years and older, the OS was only 56.5%±13.1%. Relapse occurred in 71 patients (15.4%), and the OS after relapse was 37.7%±6.0%.
Conclusion:
The treatment outcomes of patients with ALL improved markedly. However, there is a need to further characterize adolescents and young adult patients, as well as those who have experienced relapses.
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