Features Identified in Induction Failure Among Childhood ALL

Findings from a new study appearing in the latest issue of the New England Journal of Medicine indicate that researchers are getting closer to identifying those indicators in childhood acute lymphoblastic leukemia (ALL) that tend to mean a poorer prognosis following induction treatment failure.

The study, by lead author Martin Schrappe MD, Chair of the International BFM (Berlin-Frankfurt-Munster) Study Group, examined records from newly diagnosed ALL patients who were treated by a total of 14 cooperative study groups between 1985 and 2000. They analyzed the relationships among disease characteristics, treatments administered, and outcomes in these patients.

What they determined was that patients with induction failure frequently presented with high-risk features, including:

-- Older age
--High leukocyte count
--Leukemia with a T-cell phenotype
--Philadelphia chromosome
--11q23 rearrangement

At a median follow-up period of 8.3 years, the 10-year survival rate was at only around 32%.

Cases in which the patient was aged 10 or older with T-cell leukemia, the presence of an 11q23 rearrangement, and 25% or more blasts in the bone marrow at the end of induction therapy were associated with a particularly poor outcome.

High hyperdiploidy and an age of 1 to 5 years were associated with a favorable outcome in patients with precursor B-cell leukemia.

Allogeneic stem-cell transplantation from matched, related donors was also associated with improved outcomes in T-cell leukemia.

Those patients who are younger than six with precursor B-cell leukemia and no adverse genetic features had a 10-year survival rate of over 72 percent when treated with chemotherapy.

Source: NEJM