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Prognostic factors for relapse-free survival in childhood acute lymphoblastic leukaemia
Insights
Four factors at diagnosis significantly increase relapse risk in childhood acute lymphocytic leukemia (ALL). These include high white blood cell count, high lymphoblast percentage, and specific age groups (under 2 or over 5 years).
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Childhood acute lymphocytic leukemia (ALL) is the most common childhood cancer.
- Effective risk stratification is crucial for optimizing treatment strategies and improving outcomes.
- Previous studies have identified various prognostic factors, but their predictive value requires ongoing validation.
Purpose of the Study:
- To identify key prognostic variables at diagnosis that predict disease-free survival in children with acute lymphocytic leukemia.
- To evaluate the predictive significance of 11 distinct clinical and laboratory parameters in a cohort of 267 children.
Main Methods:
- A retrospective analysis of 267 children diagnosed with acute lymphocytic leukemia.
- Assessment of 11 baseline variables including leucocyte count, lymphoblast percentage, age, sex, and immunological markers.
- Statistical modeling to determine the independent prognostic value of each variable for disease-free survival.
Main Results:
- Leucocyte count > 50 x 10(9)/l, lymphoblasts > 80% in peripheral blood, age < 2 or > 5 years, and male sex significantly increased relapse risk (risk factors 1.9, 2.3, 1.7, and 1.7, respectively).
- Hemoglobin, platelet count, bleeding signs, extramedullary infiltrations, hepatosplenomegaly, mediastinal mass, and T- or B-cell immunophenotype did not show independent prognostic value in the presence of the four key variables.
- Small sample sizes limited the evaluation of T- or B-cell lymphoblast type impact.
Conclusions:
- Leukocyte count, lymphoblast percentage, age, and sex are critical prognostic indicators for childhood ALL at diagnosis.
- These factors can guide risk stratification and potentially personalize treatment intensity.
- Further research with larger cohorts is needed to fully elucidate the prognostic role of immunophenotype in ALL.
Abstract:
11 variables determined at the onset of acute lymphocytic leukaemia were tested to predict disease-free survival in 267 children. All children had received similar induction treatment and basic maintenance therapy, whereas 5 different reinforcement treatments were administered irrespective of the severity of the disease at onset. Three modes of prophylactic central nervous system treatment were employed. The risk of relapse was significantly increased for leucocyte count above 50 X 10(9)/1, lymphoblasts above 80% in peripheral blood, age below 2 years or over 5 years, and for males. The risk of relapse was increased by estimated factors of 1.9, 2.3, 1.7, and 1.7, respectively. When the above 4 variables were included in the model, no further prognostic value was demonstrated for haemoglobin concentration, platelet count, signs of bleeding in the skin, mucous membranes or intracranially, presence of leukaemic infiltrations outside the bone marrow, hepatosplenomegaly, mediastinal mass, or T- or B-cell leukaemia. However, evaluation of T- or B-lymphoblast type impact was hampered by small numbers.