Prognosis and treatment of acute lymphoblastic leukemia

Jacquillat, C; Weil, M; Auclerc, Marie-Françoise; Chastang, C; Flandrin, Georges; Izrael, V.; Schaison, G; Degos, Laurent; Boiron, M; Bernard, J

doi:10.1007/bf00254045

Cited by 20 publications

(3 citation statements)

References 22 publications

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“…The demographic and haematological characteristics of the study population were in keeping with those generally reported in this disease ( Rivera et al , 1993 ; Crist et al , 1986 ; Jacquillat et al , 1978 ). In contrast, there was a higher proportion of the FAB 2 cytological type (25%, compared to 15% in general) ( Lilleyman et al , 1992 ), probably stemming from the difficulty in applying the FAB classification in multicentre surveys.…”

Section: Discussionsupporting

confidence: 72%

“…Major progress has been made in the management of childhood acute lymphoblastic leukaemia in the last 30 years, and most patients now survive for long periods ( Cortes & Kantarjian, 1995; Rivera et al , 1993 ; Ribeiro & Pui, 1993). Nearly 50 clinical or biological potential prognostic factors have been evaluated ( Campana & Pui, 1995; Crist et al , 1986 , 1990a, b; Fletcher et al , 1991 ; Gajjar et al , 1995 ; Gibbons et al , 1990 ; Hammond et al , 1986 ; Harbott et al , 1990 ; Hecker et al , 1994 ; Hiddeman et al , 1993 ; Jacquillat et al , 1978 ; Lennard & Lilleyman, 1989; Lilleyman et al , 1992 ; Look et al , 1985 ; McLean et al , 1996 ; Miller et al , 1983 , 1989; Neglia et al , 1988 ; Pieters et al , 1992 , 1994; Privitera et al , 1992 ; Pui et al , 1987 , 1989, 1991; Raimondi et al , 1992 ; Rautonen et al , 1988 ; Riehm et al , 1986 ; Russo et al , 1991 ; Santana et al , 1990 ; Secker‐Walker et al , 1989 ; Steinherz et al , 1991 , 1996; Uckun et al , 1995 , 1996; Wiersma et al , 1991 ). These factors are at least partly interrelated ( Hammond et al , 1986 ; Pui et al , 1988 ; Robison et al , 1980 ).…”

Section: Table I Multivariate Prognostic Studies In Childhood Allmentioning

confidence: 99%

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Critical study of prognostic factors in childhood acute lymphoblastic leukaemia: differences in outcome are poorly explained by the most significant prognostic variables

et al. 1998

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Summary.We determined the proportion of survival variability explained by the usual prognostic factors in childhood acute lymphoblastic leukaemia (ALL) during a prognostic study of 1552 patients enrolled in three consecutive Fralle group protocols (Fralle 83, Fralle 87 and Fralle 89). The event-free survival rates at 5 years were 54·8% (SD 1·9), 43·1% (SD 2·7) and 55·6% (SD 2·2), respectively. In the univariate analysis the following variables were predictive of poor outcome: male gender, elevated leucocytosis (> 50 × 10 9 /l), circulating blastosis, haemoglobin >12 g/dl, platelet count <100 × 10 9 /l, age under 1 year or over 9 years, enlarged mediastinum, nodes, spleen and liver, T phenotype, absence of CD10 þ cells; testicular and meningeal involvement, poor response to induction therapy (CCSG M3), and LDH >400 U/l. Among the cytogenetic features, hyperdiploidy had a protective effect, whereas hypodiploidy, translocation and other structural abnormalities had a negative influence, particularly in cases of t(9;22) or t(4;11). Multivariate analysis summarized the prognostic information in terms of four variables: age, gender, leucocytosis and cytogenetic features. Missing data had little influence on the results. However, despite their significance in the multivariate analysis, these four variables each had very low predictive power (1·1% for gender, 2·0% for age, 3·5% for leucocytosis, and 1·6% for cytogenetic features). Thus, the most significant prognostic factors in childhood ALL each explain no more than 4% of the variability in prognosis. This may explain the disappointing practical value of these factors and underlines the need for prognostic tools in childhood ALL.

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Section: Discussionsupporting

confidence: 72%

Section: Table I Multivariate Prognostic Studies In Childhood Allmentioning

confidence: 99%

Critical study of prognostic factors in childhood acute lymphoblastic leukaemia: differences in outcome are poorly explained by the most significant prognostic variables

et al. 1998

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“…Analysis of the various prognostic factors that have been referred to in patients with ALL [6,17], showed that age had no relation to response (Table I) identical to other observations [9,13,19]. All the patients with normal or low circulating leukocyte counts had a complete remission, whereas in 10 out of 15 cases (66%) with leukocytosis, complete remission occurred, and when the leukocyte counts were higher than 50,0oO/pl, the number of cases of complete remission achieved was even smaller (40 %) (Table I).…”

Section: Resultsmentioning

confidence: 99%

Treatment of adult acute lymphoblastic leukemia with adriamycin, vincristine, and prednisone

Avilés¹,

Sinco²,

Rivera³

et al. 1983

Med. Pediatr. Oncol.

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At the present time, it is possible to achieve up to a 95% complete remission in childhood acute lymphoblastic leukemia, using the combination of vincristine and prednisone. Nevertheless, it has not been possible to reproduce these results in the adult. For this reason, a third drug, in this case adriamycin in a low dose, was added to the vincristine-prednisone combination in the treatment of adult acute lymphoblastic leukemia (ALL). Complete remission was achieved in 45 of the 50 patients (90%). The median duration of remission was 23 months and the median survival time in this group was 31 months. The complications were minimal and the tolerance was good. From the point of view of our results and others reported in the literature, we consider that the combination of vincristine, prednisone, and adriamycin is a useful method for induction of remission of adult ALL.

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High risk acute lymphocytic leukemia: A study of 141 cases with initial white blood cell counts over 100,000/cu mm

Harousseau

Tobelem

Schaison

et al. 1980

Cancer

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The cases of one hundred and forty-one patients (85 males, 56 females) treated for hyperleucocytic acute lymphocytic leukemia (H-ALL) were reviewed. In all cases the initial white blood cell count was over 100,000/cu mm. One hundred patients (71%) attained complete remission (CR). The median duration of CR was six months and the median survival was nine months for all patients and 11 months for those who attained CR. Age, initial hemoglobin, and the height of initial white blood cell count over 100,000 had no significant prognostic value. Relapses occurred earlier in patients with a mediastinal mass. The results depended on the treatment used. With modern treatment, including more intensive chemotherapy and central nervous system prophylaxis, CR rate increased from 65% to 81% and median duration of CR improved from four months to ten months. The most important prognostic difference was related to the sex: CR rate was higher (78.5% vs. 66%) and median duration of CR and hematological remission was longer for females (nine months vs. six months and ten months vs. 6.5 months, respectively). This difference only appeared with modern treatments, however: before 1972 the median duration of CR was four months for both sexes, and after 1972, it was eight months for males and 17 months for females. This difference could be explained by the site of the first relapse, which was testicular in only 2% of cases before 1972 and 27% (47% of the males who relapsed) after 1972.

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Prognosis and treatment of acute lymphoblastic leukemia

Cited by 20 publications

References 22 publications

Critical study of prognostic factors in childhood acute lymphoblastic leukaemia: differences in outcome are poorly explained by the most significant prognostic variables

Critical study of prognostic factors in childhood acute lymphoblastic leukaemia: differences in outcome are poorly explained by the most significant prognostic variables

Treatment of adult acute lymphoblastic leukemia with adriamycin, vincristine, and prednisone

High risk acute lymphocytic leukemia: A study of 141 cases with initial white blood cell counts over 100,000/cu mm

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