Clinical and biologic features predict poor prognosis in acute lymphoid leukemias in children and adolescents: A pediatric oncology group review

Abstract

Although the prognosis of children with ALL has improved markedly, approximately one-half of children continue to relapse. Clinical and biologic features of ALL have been studied at the time of diagnosis and many of these features have been shown to predict the risk of relapse, permitting tailoring of therapy based on relapse hazard. Results of studies of the Pediatric Oncology Group (POG) detailed here demonstrate that high white blood cell (WBC) count at diagnosis, very young or older age within childhood, and the presence of a mediastinal mass or central nervous system leukemia predict a poor prognosis within the context of certain therapies. However, not only age and WBC count, but immunophenotype of ALL as well, were especially predictive of prognosis in these POG studies. The information reviewed here has special importance for the planning of clinical trials for children with ALL.

Stem cell origins of leukaemia and curability

“…Addendum: exceptions that may prove the rule Infant acute leukaemias Infant (<18 months) acute leukaemias occur at a very low incidence rate but have a particularly poor prognosis (Crist et al, 1986;Pui et al, 1990). This may in part be explained by the difficulties of treating such young individuals but features of the leukaemic cell populations are also likely to be relevant.…”

Augmented Post-Induction Therapy for Children with High-Risk Acute Lymphoblastic Leukemia and a Slow Response to Initial Therapy

“…[1][2][3][4][5] The outcome for most of these children has improved with the use of intensive chemotherapy after the induction of remission, but approximately 30 percent of such high-risk patients eventually relapse. [5][6][7][8] Numerous studies have demonstrated that a rapid response to initial chemotherapy is an important prognostic factor in childhood ALL.…”

Outcome of risk-based therapy for infant acute lymphoblastic leukemia with or without an MLL gene rearrangement, with emphasis on late effects: a final report of two consecutive studies, MLL96 and MLL98, of the Japan Infant Leukemia Study Group

“…[2][3][4][5][6][7][8] ALL in infancy has several distinctive clinical characteristics compared with common childhood ALL, including hyperleukocytosis, hepatosplenomegaly, central nervous system (CNS) disease and a high frequency of molecularly evident rearrangement of the MLL gene at chromosome band 11q23. [9][10][11][12] Among these features, MLL gene rearrangement, found in 70-80% of infant ALL cases studied with molecular techniques, is an independent risk factor most predictive of recurrent leukemia. [13][14][15] The high failure rate in infants with ALL, especially those with MLL gene rearrangement, can be attributed to early relapse after remission rather than toxicity, and warrants consideration of intensified therapy.…”