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Abstract

Significance of commonly used prognostic factors differs for children with T cell acute lymphocytic leukemia (ALL), as compared to those with B-precursor ALL. A Pediatric Oncology Group (POG) studyT cell acute lymphocytic leukemia (T-ALL) and B-precursor ALL differ significantly in the clinical characteristics of the patients at presentation and in laboratory-defined characteristics of the leukemic cells. We assessed for pediatric patients with T-ALL the relative importance of prognostic factors previously demonstrated to predict outcome in B-precursor ALL. Presenting clinical and laboratory features were correlated with outcome for 441 children 12 months to 21 years of age with previously untreated T-ALL, registered on the Pediatric Oncology Group (POG) T3 protocol between 1986 and 1992. These T-ALL prognostic factor analyses were then compared to similar analyses for 1993 patients with B-precursor ALL enrolled during the same time period on the POG ALinC 14 protocol. Quantitative interaction between phenotype and each prognostic factor was studied to determine the relative importance of the prognostic factor for each of the two major immunophenotypes. We also analyzed the importance of maturational stage as a T-ALL prognostic factor, using a modified Ludwig definition of maturational stage. We conclude that several of the clinical and laboratory prognostic factors, which are used reliably for Bprecursor ALL, are much less predictive in T-ALL (ie age, WBC, consensus risk group, hyperdiploidy, presence of translocations and CALLA expression). There was no significant difference between the phenotypes in the prognostic importance of race or gender. Our data demonstrate a significant difference in outcome among the three maturational stages of Tcell ALL, with the intermediate group faring best. Using traditional risk group criteria to stratify patients with T-ALL for therapy may not be appropriate.

Final results of a single institution experience with a pediatric‐based regimen, the augmented Berlin–Frankfurt–Münster, in adolescents and young adults with acute lymphoblastic leukemia, and comparison to the hyper‐CVAD regimen

“…T-cell ALL patients may present with high WBC and yet may have acceptable OS [20]. The T-cell ALL group in our study was too small to analyze the relative importance of morphology and WBC count.…”

Gene-based outcome prediction in multiple cohorts of pediatric T-cell acute lymphoblastic leukemia: a Children's Oncology Group study

“…In the clinical setting, age and white blood cell count (WBC) at diagnosis are used to stratify B-lineage ALL patients as either standard or high risk, significantly impacting on the type and intensity of post-induction therapy used. However these NCI-defined criteria have been shown to have little prognostic value in T-ALL disease [1-3]. Improved markers are needed for outcome prediction to improve T-ALL patient stratification.…”

Adult Precursor T-Lymphoblastic Leukemia/Lymphoma with Myeloid-Associated Antigen Expression Is Associated with a Lower Complete Remission Rate following Induction Chemotherapy

“…In the GMALL trial, presenting WBC did not reach statistical significance in multivariate analysis [7] while in the JALSG trial, patients with WBC <3 × 10 9 /l or >50 × 10 9 /l had a worse outcome than patients with a WBC of 3–50 × 10 9 /l [5]. The Pediatric Oncology Group study of pediatric T-ALL reported a similar trend as patients with WBC <10 × 10 9 /l or >50 × 10 9 /l did worse than patients with a WBC of 10–50 × 10 9 /l [20]. In our T-ALL cohort, initial WBC [analyzed as a continuous variable or categorically using 3, 10 and 50 as cutoffs according to previous reports (data not shown)] did not influence outcome.…”