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High‐risk childhood acute lymphoblastic leukemia in China: Factors influencing the treatment and outcome
Author(s) -
Luo XueQun,
Ke ZhiYong,
Huang LiBin,
Guan XiaoQing,
Zhang YingChuan,
Zhang XiaoLi
Publication year - 2009
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.21810
Subject(s) - medicine , prednisone , white blood cell , chemotherapy , acute lymphocytic leukemia , induction chemotherapy , leukemia , pediatrics , lymphoblastic leukemia
Objective Acute lymphoblastic leukemia (ALL) with high‐risk features has an inferior outcome. Factors influencing the treatment and outcome of pediatric ALL with high‐risk features in developing countries have not been well studied. Methods High‐risk features were defined as: age <1 year or >10 years, white blood cell (WBC) > 50 × 10 9 /L, CNS or testicular involvement at diagnosis, T‐ALL, BCR‐ABL/MLL‐AF4, poor prednisone response, slow early response to induction chemotherapy which was defined as M3 status (>25% blasts) on day 15 bone marrow with age >6 years or presenting WBC > 20 × 10 9 /L at diagnosis and/or non‐remission (NR) after 33 days of induction therapy. Results Ninety‐one children were analyzed. The total rate of treatment abandonment was 24.2% and treatment‐related mortality was 3.3% (3/91). The event‐free survival (EFS) was 52.3% (95% CI, 41.5–63.1%) at 4 years and 49.9% (95% CI, 38.9–60.9%) at 8 years, respectively. When the cases who abandoned treatment were excluded, the EFS of the remainder was 68.3% (95% CI, 56.5–80.1%) at 4 years and 65.2% (95% CI, 52.5–77.9%) at 8 years, respectively. NR on day 33 or BCR‐ABL remained as an independent unfavorable prognostic factor in the Cox model even if more intense chemotherapy was administrated. Conclusion A decreased treatment‐related death frequency was associated with an improved outcome of leukemia. This emphasizes the importance of improving supportive care in developing countries for children with high‐risk ALL who receive very intensive chemotherapy. Treatment abandonment remains a prominent reason for treatment failure in China. Pediatr Blood Cancer 2009;52:191–195. © 2008 Wiley‐Liss, Inc.