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Improved survival for acute lymphoblastic leukaemia in infancy: the experience of EORTC-Childhood Leukaemia
A Ferster1, Y Bertrand, Y Benoit
1Department of Haemato-Oncology, Hôpital Universitaire des Enfants, Brussels, Belgium.
Insights
Infant acute lymphoblastic leukemia (ALL) treatment shows improved outcomes with EORTC-CLCG protocols, but survival rates remain lower than in older children, necessitating further research.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Trials
Background:
- Infant acute lymphoblastic leukemia (ALL) is a rare and aggressive form of childhood cancer.
- Treatment protocols for infant ALL have evolved, but outcomes often lag behind those of older children.
Purpose of the Study:
- To evaluate the efficacy of EORTC-CLCG protocols 58831 and 58832 in newly diagnosed infants (<1 year) with ALL.
- To identify prognostic factors influencing treatment outcomes in this specific patient group.
Main Methods:
- Retrospective analysis of 28 infants (<1 year) diagnosed with ALL and treated under EORTC-CLCG protocols.
- Assessment of clinical data, including risk factors (leukocyte count, organomegaly), cytogenetics (e.g., t(4;11) translocation), and treatment response.
Main Results:
- Complete remission (CR) achieved in 86% of cases; overall event-free survival (EFS) was 43%.
- Elevated risk factors were present in 25 infants; t(4;11) translocation identified in 6 out of 9 infants with chromosomal abnormalities.
- EFS did not differ significantly between very young infants and those older than 6 months.
Conclusions:
- EORTC-CLCG protocols demonstrate improved, yet still inferior, outcomes for infant ALL compared to older children.
- Patients without AUL or t(4;11) translocation showed a CR rate >50% with a 4-year median follow-up.
- Further large cooperative trials are essential to enhance treatment strategies and outcomes for infant ALL.
Abstract:
Out of 744 newly diagnosed ALL children under the age of 18 years treated according to the EORTC-CLCG protocols 58831 and 58832, 28 (4%) were infants less than 1 year of age. An elevated risk factor, which takes into account the sizes of the liver and spleen and the number of circulating blasts, was present in 25 cases. Most patients had non-common ALL. Among 15 patients studied by cytogenetics, nine present chromosomal abnormalities, six of them having a t(4;11) translocation. Complete remission was achieved in 86% of cases. One patient died in complete remission of therapy-related infection. The overall EFS is 43%. It is not statistically different in very young infants as compared to infants older than 6 months. Except for patients with AUL or with t(4;11) translocation, a continuous complete remission rate above 50% can be achieved with a median follow-up of 4 years. The results obtained in infant ALL with EORTC-CLCG protocols are currently better than those obtained with some other protocols, but remains inferior when compared to the ones obtained in older children. Thus, further improvements are needed and should be evaluated in large cooperative trials.