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The role of immunophenotype in acute lymphoblastic leukemia of infant age
G Basso1, R Rondelli, A Covezzoli
1Dipartimento di Pediatria, University of Padova, Italy.
Insights
Infant acute lymphoblastic leukemia (ALL) has a poorer prognosis due to immature phenotypes and high white blood cell (WBC) counts. Immunophenotypic analysis, alongside clinical data, is crucial for improving infant ALL therapy and outcomes.
Area of Science:
- Pediatric Oncology
- Hematology
- Immunology
Background:
- Infant acute lymphoblastic leukemia (ALL) presents a significant survival challenge compared to older children.
- Prognostic difficulties are attributed to clinical factors (e.g., high white blood cell counts) and biological markers (e.g., immature phenotypes, cytogenetic abnormalities).
Purpose of the Study:
- To evaluate the prognostic significance of immunophenotypic analysis in infants with ALL.
- To correlate immunophenotype with clinical data, including white blood cell (WBC) counts and age.
Main Methods:
- Retrospective review of immunophenotypic studies from 145 infants (<18 months) treated between 1984-1992.
- Analysis of WBC counts at diagnosis (mean values and categories: <10.10(9)/L, >100.10(9)/L).
- Correlation of immunophenotype and specific marker expression with age and WBC counts.
Main Results:
- A significant association was observed between younger age, elevated WBC counts, and immature immunophenotypes in infant ALL.
- Common ALL subtypes were more prevalent in older children and associated with lower WBC counts.
- Event-free survival was notably better in older children with WBC counts <100.00/mm3 and specific immunophenotypes (CD10+, MyAg-).
Conclusions:
- Immunophenotypic analysis remains a vital prognostic tool for infant ALL.
- Integrating immunophenotypic data with clinical parameters aids in tailoring therapeutic strategies for infants diagnosed with ALL.
Abstract:
The prognosis of acute lymphoblastic leukemia in infants is still significantly worse than that of older children. This is thought to be due to both clinical and biological factors, such as high white blood cell (WBC) counts at diagnosis, irregular or immature phenotypes, and molecular and cytogenetical abnormalities. In order to focus the significance of immunophenotypic analysis, we have reviewed the immunophenotypic studies of 145 infants under 18 months of age treated at the AIEOP centers from 1984 to 1992. Children have been divided in three age groups of six months each; WBC count at diagnosis has been evaluated both as mean values and within different categories (< 10.10(9)/L, > 100.10(9)/L). These have been studied in correlation with immunophenotype and with the expression of single, specific markers. A significant correlation has been found between young age, high WBC count and immature phenotypes. Common ALL was more frequent in older children and showed lower WBC counts. Moreover, event-free survival was significantly better in older children with WBC count < 100.00/mm3, with CD10+, MyAg- ALL. Therefore, we suggest that immunophenotypic analysis is still an important prognostic factor and can be usefully used, together with simple clinical data, to plan therapy for ALL in infants.