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Prognostic variables and survival in pediatric acute lymphoblastic leukemias: cancer institute experience
V Shanta1, V Maitreyan, T G Sagar
1Division of Medical Oncology, Cancer Institute, Madras, India.
Insights
This study analyzed prognostic factors in pediatric acute lymphoblastic leukemia (ALL). Age at diagnosis was the only independent risk factor, with survival rates comparable to similar international studies.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Pediatric acute lymphoblastic leukemia (ALL) presents unique prognostic challenges.
- Many patients in this cohort exhibited multiple high-risk factors at diagnosis.
- Previous treatment protocols may not have adequately addressed poor-risk ALL characteristics.
Purpose of the Study:
- To analyze front-line prognostic variables for complete response, continuous complete remission, and disease-free survival in pediatric ALL.
- To identify independent risk factors influencing outcomes in a poor-prognostic group.
- To evaluate the efficacy of a pilot treatment protocol for high-risk pediatric ALL.
Main Methods:
- Analysis of clinical characteristics and prognostic factors in 97 pediatric ALL patients treated between 1983-1988.
- Utilized the Cox proportional hazard model to assess the significance of prognostic variables.
- Employed the Kaplan-Meier method for survival data analysis, including relapse-free and event-free survival.
Main Results:
- Nearly all patients presented with multiple adverse prognostic factors, including age, white blood cell count, blast count, organomegaly, and L2 morphology.
- Age at presentation was the sole independent risk factor identified.
- Relapse-free survival was 50.7% and event-free survival was 38.1% at 10 years.
Conclusions:
- Age is a critical independent prognostic factor in pediatric ALL.
- The pilot protocol demonstrated comparable survival outcomes to international standards for similar high-risk groups.
- Further research into optimizing treatment for poor-risk pediatric ALL is warranted.
Abstract:
This presentation is an analysis of front-end prognostic variables in achieving a complete response, a continuous complete remission, and disease-free survival in pediatric acute lymphoblastic leukemia at the Cancer Institute, Madras, India between 1983 and 1988. The clinical characteristics at presentation showed that virtually 100% of patients belong to the poor risk category, age < 3 years of > 6 years 72.2%, WBC > 10,000/mm3 59.8%, blast count > 50% 39.2%, organomegaly 91.8%, and L2 morphology 66.0%. All patients had more than one risk factor. Between 1983 and 1988, 97 children were treated on a pilot protocol designed in collaboration with the Lymphoma Biology Division of the Pediatric Oncology Branch of the National Cancer Institute, Bethesda, Maryland. The protocol was designed for a poor prognostic group. The significance of implicated poor prognostic factors was analyzed using the Cox proportional hazard model. Age at presentation was the only variable that emerged as an independent risk factor, and sex appeared to be a modifier. No other variables attained significance. Survival data were calculated by the Kaplan-Meier method. The relapse-free and event-free survivals up to 10 years were 50.7% and 38.1%, and compare reasonably well with results reported for similar groups elsewhere for the same period.