Outcome of Pediatric Acute Lymphoblastic Leukemia: Sixty Years of Progress

Abstract

Background: A retrospective analysis was performed to investigate the survival outcomes in pediatric acute lymphoblastic leukemia (ALL) based on time period. We hypothesized that improvement has been obtained with the time-dependent therapeutic era and rise in the gross domestic product (GDP) and Human Development Index (HDI). Materials and Methods: Data from 710 children who were treated for ALL between 1958 and 2018 at a single pediatric center were analyzed for probability of 5-year overall survival (pOS), event-free survival (pEFS) and relapse risk (pRR). Time periods were defined by the treatment protocols used in seven consecutive therapeutic eras. Results: Over the 60-year period analyzed, pOS increased from 1.2% to 90.7%, pEFS from 1.2% to 86.6%, and pRR decreased from 98.8% to 9.9% for patients treated in the past decade. Risk of mortality for patients who received chemotherapy and hematopoietic cell transplant was reduced to 9.9% in the recent era, however, no statistically significant survival difference was found between patients treated with stem cell transplant and those not. Conclusion: The therapeutic era, related to improved GDP and HDI, was a statistically significant predictor of increased OS from ALL.

Identification of a Seven-lncRNA-mRNA Signature for Recurrence and Prognostic Prediction in Relapsed Acute Lymphoblastic Leukemia Based on WGCNA and LASSO Analyses

“…Acute lymphoblastic leukemia (ALL) which results from the clonal proliferation of immature T- or B-lymphoid cells in the bone marrow is the most common malignant hematologic disorder in childhood, accounting for approximately 35% of all childhood malignancies [ 1 , 2 ]. Chemotherapy is the main therapeutic approach for childhood ALL, with the rate of complete remission (CR) being achieved higher than 90% [ 3 ]. However, 10% of patients still will experience relapse, leading to their eventual death [ 3 , 4 ].…”

“…Chemotherapy is the main therapeutic approach for childhood ALL, with the rate of complete remission (CR) being achieved higher than 90% [ 3 ]. However, 10% of patients still will experience relapse, leading to their eventual death [ 3 , 4 ]. Thus, it is considerably essential to early identify cases at a high risk of relapse and predict their overall survival (OS) to schedule more individualized treatments.…”

Bone morbidity in pediatric acute lymphoblastic leukemia

“…2) After successful evolution of chemotherapy and clinical trials spanning 5 decades, the current curability rate of ALL is approximately 90% in resource-rich countries. 3) Endocrine disorders are highly prevalent among cancer survivors; recent data indicate that 40%-50% of survivors will develop at least one endocrinopathy once in their lifetime. 4) Endocrine dysfunction is encountered in pediatric patients with ALL during and after therapy and might arise in the long term.…”

Acute non-hematological toxicity of intensive chemotherapy of acute lymphoblastic leukemia in children

“…Patients treated for ALL after 2011 have currently 91% probability of overall survival [2]. The main cause of treatment failure is relapse; however, toxicity of chemotherapy is a severe issue [9,11].…”

“…Acute lymphoblastic leukemia (ALL) is the most frequent type of pediatric leukemia constituting 80-85% of all cases [1]. Progress in diagnostics and therapy for leukemia has led to the cure rate of 70-80% in the beginning of 21st century, compared to <1% in the 1960s of the 20th century [2,3]. Due to the rarity of the disease, children with ALL are usually treated according to the international protocols [4,5].…”