Mediastinal mass in childhood T‐cell acute lymphoblastic leukemia: Significance and therapy response

Abstract

We failed to show that in children with T-ALL residual mediastinal tumors are of prognostic relevance. This might suggest that incomplete local response is not necessarily an indication for treatment intensification such as local irradiation, second-look operation, or high-dose chemotherapy with bone marrow rescue. However, due to the relatively small number of patients analyzed, our results have to be validated prospectively on a larger cohort of patients in future clinical trials.

High survival rate with the LMT-89 regimen in lymphoblastic lymphoma (LL), but not in T-cell acute lymphoblastic leukemia (T-ALL)

“…The prognostic relevance of residual mediastinal infiltration in patients with bulky disease at presentation has not been assessed in adult patients, but did not seem to influence long-term outcome in childhood. 18 Furthermore, an early randomized prospective trial of mediastinal radiotherapy in childhood LL showed no clinical benefit but increased toxicity following radiotherapy. 19 We did not plan mediastinal irradiation in our protocol and only 3/14 relapses was localized in the mediatinum.…”

Bone marrow minimal disseminated disease (MDD) and minimal residual disease (MRD) in childhood T‐cell lymphoblastic lymphoma stage III, detected by flow cytometry (FC) and real‐time quantitative polymerase chain reaction (RQ‐PCR)

“…In contrast to ALL, very few prognostic factors have been identified in T-LLy, such as disease stage III versus IV [11,[13][14][15] and early response to treatment, as measured by resolution of the mediastinal mass [11,16,17], and their significance is controversial, depending on the therapy delivered. Early treatment response, expressed by levels of minimal residual disease (MRD) in bone marrow (BM)/peripheral blood (PBL), has proven to be a powerful predictor of treatment outcome [18][19][20][21][22][23][24] and was introduced to recent ALL treatment protocols for risk-group stratification [24,25].…”

Shortness of breath in an infant with history of acute lymphoblastic leukemia

“…In the past, the prognosis for patients with mediastinal masses was supposedly poor; however, new studies using more advanced treatment show that this supposition may be false (3). The prognosis is usually better for patients in whom the mediastinal mass resolves within 60 days after start of treatment (4).…”