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Infant leukemia in Japan: clinical and biological analysis of 48 cases
E Ishii1, J Okamura, M Tsuchida
1Department of Pediatrics, Kyushu University, Fukuoka, Japan.
Insights
Infant acute leukemia, both lymphoid (ALL) and nonlymphoid (ANLL), shows distinct morphological and chromosomal features. Hyperleukocytosis indicates a poorer prognosis for ALL infants, necessitating intensive chemotherapy.
Area of Science:
- Pediatric Oncology
- Hematology
- Cell Biology
Background:
- Infant acute leukemia presents diagnostic and prognostic challenges.
- Understanding the specific subtypes and characteristics of infant leukemia is crucial for effective treatment.
Purpose of the Study:
- To analyze clinical and laboratory data of Japanese infants diagnosed with acute lymphoid leukemia (ALL) and acute nonlymphoid leukemia (ANLL).
- To investigate morphological, chromosomal, and surface marker profiles of infant leukemia subtypes.
- To evaluate prognostic factors, including hyperleukocytosis, and survival rates.
Main Methods:
- Clinical and laboratory data from 48 Japanese infants (24 ALL, 24 ANLL) were analyzed.
- Morphological classification (FAB L1, M4/M5), physical examination findings (hepatosplenomegaly), and laboratory values (hyperleukocytosis) were recorded.
- Chromosome studies, surface marker analysis (HLA-DR, CD19, CD10), and relapse data were examined.
Main Results:
- Morphological subtypes identified: FAB L1 for ALL (20/24) and M4/M5 for ANLL (20/24).
- Abnormal karyotypes were frequent in ANLL (19/22) compared to ALL (9/21), with common abnormalities including translocation 11, 12, and inversion 16.
- Common ALL (HLA-DR+, CD19+, CD10+) was diagnosed in only 32% (7/22) of ALL infants.
- Relapse rates were higher in ALL (63%) within 2 years compared to ANLL (38%) within 1 year.
- Infants with ALL and hyperleukocytosis had a significantly poorer event-free survival (p < 0.05).
Conclusions:
- Infant leukemia likely originates from a multipotent cell with lymphoid and myeloid potential.
- Distinct morphological and chromosomal features differentiate ALL and ANLL in infants.
- Intensive multiagent chemotherapy is essential for treating infant acute leukemia, with hyperleukocytosis being a critical prognostic indicator for ALL.
Abstract:
Forty-eight Japanese infants with acute lymphoid leukemia (ALL) (n = 24) and acute nonlymphoid leukemia (ANLL) (n = 24) were analyzed on the basis of clinical and laboratory data. Morphologically, 20 of the 24 infants with ALL were of the FAB L1 type, and 20 of the 24 infants with ANLL were of the M4 or M5 type. Markedly enlarged liver and spleen, and hyperleukocytosis (more than 50,000/microliters) were seen in 9, 12, and 14 infants with ALL and 10, 11, and 10 infants with ANLL, respectively. Initial CNS leukemia was evident in 2 infants. Chromosome studies of the leukemic cells showed abnormal karyotypes in 9 of the 21 infants with ALL and 19 of the 22 infants with ANLL, consisting mainly of translocation 11, 12, and inversion 16. By surface marker analysis, only 7 of the 22 infants with ALL (32%) were diagnosed as having common ALL (HLA-DR+, CD19+, CD10+). Of the 15 infants with ANLL, 12 and 5 infants also showed reactivity to HLA-DR and CD19, respectively. All of the 5 ANLL infants with lymphoid markers showed different leukemic cell features at the time of relapse. Twelve of the 19 infants with ALL (63%) who achieved a complete remission relapsed within the first 2 years; 8 of the 21 with ANLL (38%) relapsed within the first year. Analysis of event-free survival shows that the ALL infants with hyperleukocytosis have a poorer prognosis than those without hyperleukocytosis (p less than 0.05). Infant leukemia originates in a multipotent cell with lymphoid and myeloid features, and intensive multiagent chemotherapy is necessary for the treatment of infants with acute leukemia.
