Initial and late prognostic factors to predict survival in adult acute lymphoblastic leukaemia

Abstract

Factors able to predict overall survival in adult patients with acute lymphoblastic leukaemia were assessed according to the period since initiation of the treatment using a Cox proportional hazards model. This period covers successively an initial period during the induction treatment and a consolidation period during the postinduction treatment. From 1994 to 2002, 922 patients with acute lymphoblastic leukaemia (excluding French-American-British L3 subtype) were enrolled in a multicentre protocol and followed, with a mean follow up of 58 months. A multivariate time-segmented analysis was performed on 658 patients. Analyses of the initial (before 100 d) and the late phases were realised after stratification on the type of induction treatment and on the different treatment strategies respectively. Age was the sole factor that influenced survival during the initial phase (hazard ratio 1.48 per 10-yr increase; P < 0.01). Factors that predicted survival during the late phase were age (hazard ratio 1.12, P = 0.02), white blood cells count (hazard ratio 1.01 per 10(10) cells/L increase; P < 0.05), lactic dehydrogenase level (hazard ratio 1.001 for 10 IU/L increase; P < 0.01) and t(9;22) karyotype or miscellaneous others vs. normal karyotype (hazard ratios 1.40; P < 0.01 and 1.06; P = 0.04 respectively). This analysis suggests that predictive factors may be split into tolerance factors and haematological factors. Determination of such factors is crucial to adapt postremission therapeutic strategies in acute lymphoblastic leukaemia.

Adult acute lymphoblastic leukemia

“…Table 2 summarizes prognostic variables that have been established by several groups in the United States and Europe. [39][40][41][42][43] New information about associations with molecular markers continues to add to an increasingly comprehensive risk stratification of patients. For example, gene expression analysis in T-lineage ALL has demonstrated high expression of the v-ets erythroblastosis virus E26 oncogene-like (ERG) and the T-cell leukemia orphan homeobox gene (HOX11L2) as unfavorable features.…”

Thymic Immunophenotype, and Expression of CD4 and Myeloid Antigens is Associated with Outcome in Adult Patients with T�Cell Acute Lymphoblastic Leukemia

“…The diagnosis of acute leukemia and its classification was based initially on French-American-British system [16,17] and later on the World Health Organization scheme [18,19]. The patients were stratified into standard or high risk groups based on WBC count (≥100×10 9 /L), karyotype (complex karyotype, hypodiploidy, aberrations involving 11q23 and t (1;19), and inability to achieve CR after the first course of chemotherapy [20]. Patients with incomplete immunophenotyping data, those re-classified after review and those who did not get therapy on our in-house protocol (ALL89-1A) were excluded from further analysis.…”

Evidence-Based Guided Interventions in Acute Leukemia

“…While the remission rate reaches 90%, the survival rate is only 40%-50% (Fielding 2008). ALL patients are stratified and treated according to algorithms that integrate the presenting features, leukemia features and early response to therapy (Faderl, et al 2003); However the classification to standard and poor risk disease varies among the major studies conducted in adult ALL patients (Hoelzer, et al 1988, Kantarjian, et al 2004, Lazarus, et al 2006, Le, et al 2006, Rowe, et al 2005, Ram, et al 2010.…”