Acute lymphoblastic leukemia in children and adolescents: prognostic factors and analysis of survival

Abstract

ObjectiveTo describe the clinical and laboratory features of children and adolescents with acute lymphoblastic leukemia treated at three referral centers in Ceará and evaluate prognostic factors for survival, including age, gender, presenting white blood cell count, immunophenotype, DNA index and early response to treatment.MethodsSeventy-six under 19-year-old patients with newly diagnosed acute lymphoblastic leukemia treated with the Grupo Brasileiro de Tratamento de Leucemia da Infância – acute lymphoblastic leukemia-93 and -99 protocols between September 2007 and December 2009 were analyzed. The diagnosis was based on cytological, immunophenotypic and cytogenetic criteria. Associations between variables, prognostic factors and response to treatment were analyzed using the chi-square test and Fisher's exact test. Overall and event-free survival were estimated by Kaplan–Meier analysis and compared using the log-rank test. A Cox proportional hazards model was used to identify independent prognostic factors.ResultsThe average age at diagnosis was 6.3 ± 0.5 years and males were predominant (65%). The most frequently observed clinical features were hepatomegaly, splenomegaly and lymphadenopathy. Central nervous system involvement and mediastinal enlargement occurred in 6.6% and 11.8%, respectively. B-acute lymphoblastic leukemia was more common (89.5%) than T-acute lymphoblastic leukemia. A DNA index >1.16 was found in 19% of patients and was associated with favorable prognosis. On Day 8 of induction therapy, 95% of the patients had lymphoblast counts <1000/μL and white blood cell counts <5.0 × 109/L. The remission induction rate was 95%, the induction mortality rate was 2.6% and overall survival was 72%.ConclusionThe prognostic factors identified are compatible with the literature. The 5-year overall and event-free survival rates were lower than those reported for developed countries. As shown by the multivariate analysis, age and baseline white blood cell count were independent prognostic factors.

Rates and trends of childhood acute lymphoblastic leukaemia: an epidemiology study

“…Age and gender. The mean age group of our study is slightly older than the (3-6) years reported by the Multi-Institutional International Collaborative Study (CALLME1) by the Middle East Childhood Cancer Alliance (MECCA) in which they comprised 33.8% 6 , older than what was found in the US of (1-4) years comprising (42.9%) 11,12 , and one international study that covered 184 countries which found the peak age to be (0-4) www.nature.com/scientificreports www.nature.com/scientificreports/ years 13 , but was close to the age reported in the Tehran study with a mean age of 5.5 years 14 and a Brazilian study which had the average age of diagnosis of 6.3 ± 0.5 years 15 . Gender ratio of M/F in our study was (1.56:1) which was slightly higher than the CALLME1 study (1.4:1), the US study (1.35:1), the international study (1.4:1), and the Tehran study (1.32:1), but lower than what was found in the Brazilian study (1.9:1) but there was no significant difference (P > 0.05) when comparing our study with all previous studies.…”

Clinical and Laboratory Manifestation of Children with Acute Lymphoblastic Leukemia as an Assessment of Severity: A Study in Dr. Hasan Sadikin General Hospital

“…These findings are similar to other reports where a large proportion of ALL patients are classified for having severe anemia. 12,15 Leukocytosis is commonly presented in ALL patients. Similarly to the findings in Iran and Brazil, where most patients have leukocytosis.…”

“…17 Similarly founded in Brazil where the majority of their ALL patients have thrombocytopenia. 15 The differentiation process of lymphoid cells is blocked in ALL patients, while their production and proliferation are uncontrolled, which result in blast cells findings in peripheral blood smear and bone marrow. ALL can be presumed with blast cells count results >5%, however for definite diagnosis of ALL, 20% blast cells or more is needed.…”

The impact of immunological and biomolecular investigations on the outcome of children with acute lymphoblastic leukemia - experience of IIIrd Paediatric Clinic Timisoara

“…(14-18) The most valuable markers, for their predictive value, are the immunological and biomolecular features of the leukemic cells. (19)(20)(21) The identification of fusion genes was used for risk stratification and as prognostic markers. Genetic anomalies were found in 25.7% of the patients enrolled in this study.…”