Prognostic factors in childhood T-cell acute lymphoblastic leukemia: a Pediatric Oncology Group study

Abstract

Two hundred fifty-three children with newly diagnosed T-cell acute lymphoblastic leukemia (ALL), who were treated uniformly with modified LSA2L2 therapy, were evaluated using univariate and recursive partition analyses to define clinical or biologic features associated with risk of treatment failure. Overall event-free survival (EFS) at 4 years was 43% (SE = 4%). Factors examined included white blood cell (WBC) level, age, gender, race (black v other), presence of a mediastinal mass, hepatomegaly, splenomegaly, marked lymphadenopathy, hemoglobin level, platelet count, blast cell expression of antigens such as the common acute lymphoblastic leukemia antigen (CALLA, CD10), HLA-DR, and T-cell- associated antigens (CD3, CD4, CD8, CD7, CD5, and THY). Univariate analysis showed that age less than or equal to 5 or less than or equal to 7 years, WBC level less than 10, less than 25, less than 50 or less than 100 x 10(3)/microL, and blast cell expression of CD4, CD8, or CALLA were associated with significantly better EFS, while hepatomegaly and splenomegaly were associated with worse EFS. Recursive partitioning analysis showed that the most important single favorable prognostic factor was a WBC level less than 50 x 10(3)/microL and, for patients with WBC counts below this level, the most important predictor of EFS was blast cell expression of the pan-T antigen defined by the monoclonal antibody (MoAb), L17F12 (CD5). For patients with higher WBC levels, the most important predictor of EFS was blast cell expression of THY antigen. The recursive partitioning analysis defined three groups of patients with widely varied prognoses identified as follows: (1) those with a WBC count less than 50 x 10(3)/microL who lacked massive splenomegaly and had blasts expressing CD5 had the best prognosis (66%, SE = 7%, EFS 4 years, n = 84); (2) those with (b1) WBC counts less than 50 x 10(3)/microL with either massive splenomegaly or who had blasts lacking CD5 expression, or (b2) WBC counts greater than 50 x 10(3)/microL with expression of the THY antigen had an intermediate prognosis (39%, SE = 7% EFS at 4 years, n = 94); (3) those with WBC counts greater than 50 x 10(3)/microL and whose blasts lacked expression of THY antigen had the poorest outcome (EFS = 19% at 4 years, SE = 8%, n = 63). A three-way comparison of EFS according to these groupings showed significant differences among the three patient groups (P less than .001). The recursive partitioning was able to classify 241 (95%) of the patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Clinical and cytogenetic features of a population‐based consecutive series of 285 pediatric T‐cell acute lymphoblastic leukemias: Rare T‐cell receptor gene rearrangements are associated with poor outcome

“…Ideogram displaying the breakpoint distribution in the 85 pediatric T-ALLs harboring structural chromosome aberrations with detailed breakpoint information. Shuster et al, 1990;Aricò et al, 1995) but not all previous investigations (Pui et al, 1990;Pullen et al, 1999;Ballerini et al, 2008;van Grotel et al, 2008).…”

Intensive high-dose asparaginase consolidation improves survival for pediatric patients with T cell acute lymphoblastic leukemia and advanced stage lymphoblastic lymphoma: a Pediatric Oncology Group study

“…Acute lymphoblastic leukemia (ALL) of T cell lineage comprises 10-15% of all cases of childhood ALL. [22][23][24][25] Children with advanced stage lympho-Correspondence: MD blastic lymphoma usually have T lineage disease, and patients with both of these disease entities are at high risk of treatment failure. [26][27][28][29][30][31][32][33][34] Initial efforts by the Pediatric Oncology Group (POG) to improve survival in patients with these aggressive T cell lymphoid malignancies used modifications of the Memorial Sloan Kettering LSA 2 L 2 regimen.…”

Effectiveness of high-dose MCNU therapy and hematopoietic stem cell autografts treatment of childhood acute leukemia/lymphoma with high-risk features

“…The T-phenotype or Bphenotype of the leukemic cells, infants with la' and common acute lymphoblastic leukemia antigen (CALLA),-and slow response or primary resistance to first-line induction chemotherapy are among the most important prognostic indicators. [17][18][19][20][21][22] Ten patients were treated in their second CR. Eight of these experienced a relapse in bone marrow with or without extramedullary (CNS, testes) involvements within 13 months of chemotherapy.…”