Factors influencing survival after relapse from acute lymphoblastic leukemia: a Children's Oncology Group study

Abstract

Despite great progress in curing childhood acute lymphoblastic leukemia (ALL), survival after relapse remains poor. We analyzed survival after relapse among 9585 pediatric patients enrolled on Children's Oncology Group clinical trials between 1988 and 2002. A total of 1961 patients (20.5%) experienced relapse at any site. The primary end point was survival. Patients were subcategorized by the site of relapse and timing of relapse from initial diagnosis. Time to relapse remains the strongest predictor of survival. Patients experiencing early relapse less than 18 months from initial diagnosis had a particularly poor outcome with a 5-year survival estimate of 21.0±1.8%. Standard risk patients who relapsed had improved survival compared with their higher risk counterparts; differences in survival for the two risk groups was most pronounced for patients relapsing after 18 months. Adjusting for both time and relapse site, multivariate analysis showed that age (10 þ years) and the presence of central nervous system disease at diagnosis, male gender, and T-cell disease were significant predictors of inferior post-relapse survival. It can be noted that there was no difference in survival rates for relapsed patients in earlier vs later era trials. New therapeutic strategies are urgently needed for children with relapsed ALL and efforts should focus on discovering the biological pathways that mediate drug resistance.

Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000

“…[68][69][70][71][72][73][74][75][76][77][78] While in the era of genomics the number of papers in the field of leukemia has risen amazingly, it remains difficult to filter out the information, which can be used for improved treatment quality and better prevention of disease recurrence. Certainly one prerequisite is reproducibility of data, and thus, uniform approaches are needed if such techniques shall be used routinely in clinical diagnostics and for risk assessment.…”

Routine Cytogenetic Analysis of Chromosome Abnormalities in Acute Lymphoblastic Leukemia

“…In a diagnostic cytogenetics laboratory for hematological malignancies, supplementary tests such as FISH and RT-PCR studies are usually performed as well. Although the five-year survival rate of children with ALL has exceeded 85%, survival after relapse remains poor [41]. Cytogenetic and molecular cytogenetic studies revealed chromosomal abnormalities in only about 80% of ALL [42].…”

CART‐cells merge into the fast lane of cancer care

“…Adult patients with relapsed or refractory ALL have a poor prognosis and almost all patients will die from their disease [21][22][23][24][25][26][27][28]. While children are initially more responsive to traditional salvage chemotherapy approaches than adults, these remissions are often not sustained and relapsed ALL remains a leading cause of cancer deaths in children [29,30]. It is this dismal prognosis and lack of conventional treatment options, which underscores the impact of the dramatic responses observed with CD19-CAR T-cell therapy in patients with relapsed and refractory ALL [1,3,4,31,32].…”