Prognostic Factors for Leukemic Induction Failure in Children With Acute Lymphoblastic Leukemia and Outcome After Salvage Therapy: The FRALLE 93 Study

Author:

Oudot Caroline1,Auclerc Marie-Françoise1,Levy Vincent1,Porcher Raphaël1,Piguet Christophe1,Perel Yves1,Gandemer Virginie1,Debre Marianne1,Vermylen Christiane1,Pautard Brigitte1,Berger Claire1,Schmitt Claudine1,Leblanc Thierry1,Cayuela Jean-Michel1,Socie Gérard1,Michel Gérard1,Leverger Guy1,Baruchel André1

Affiliation:

1. From the Service d’Hématologie et Oncologie Pédiatrique, Hôpital Mère-Enfant, Limoges; Service de Pédiatrie à Orientation Hématologique; Centre d’Investigations Cliniques; L’Institut National de la Santé et de la Recherche Médicale U717; Département de Biostatistique et Informatique Médicales; Laboratoire d’Hématologie Moléculaire, Service de Greffe de Moelle; Hôpital St Louis, Assistance Publique–Hôpitaux de Paris (AP-HP); Service d’Hématologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP; Service...

Abstract

Purpose To identify prognostic factors and to evaluate the outcome of children with acute lymphoblastic leukemia (ALL) failure after induction therapy. Patients and Methods Between June 1993 and December 1999, 1,395 leukemic children were included in the French Acute Lymphoblastic Leukemia 93 study. Results Fifty-three patients (3.8%) had a leukemic induction failure (LIF) after three- or four-drug induction therapy. In univariate analysis, high WBC count (P = .001), mediastinal mass (P = .017), T-cell phenotype (T-ALL; P = .001), t(9;22) translocation (P = .001), and a slow early response (at day 8 and/or on day 21, P = .001) were predictive of LIF. The following three prognostic groups for LIF were identified by multivariate analysis: a low-risk group with B-cell progenitor (BCP) ALL without t(9;22) (odds ratio [OR] = 1), an intermediate-risk group with T-ALL and a mediastinal mass (OR = 7.4, P < .0001), and a high-risk group with BCP-ALL and t(9;22) or T-ALL without a mediastinal mass (OR = 28.4, P < .0001). Complete remission (CR) was subsequently obtained in 43 patients (81%). The 5-year overall survival (OS) rate of the 53 patients was 30% ± 6%. The 5-year OS rate among allogeneic graft recipients, autologous graft recipients, and after chemotherapy were 30.4% ± 9.6% (50% ± 26% after genoidentical transplantation), 50% ± 17.7%, and 41.7% ± 14.2%, respectively (P = .18). Fourteen patients (26%) were still in first CR after a median of 83 months (range, 53 to 117 months). Conclusion Three risk categories for LIF in children with ALL were identified. Approximately one third of patients with LIF can be successfully treated with salvage therapy overall. Subsequent CR after LIF is mandatory for cure.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

Reference73 articles.

1. Acute Lymphoblastic Leukemia

2. Children's Cancer Group trials in childhood acute lymphoblastic leukemia: 1983–1995

3. Improving outcome through two decades in childhood ALL in the Nordic countries: the impact of high-dose methotrexate in the reduction of CNS irradiation

4. Co-operative study group for childhood acute lymphoblastic leukemia (COALL): long-term follow-up of trials 82, 85, 89 and 92

5. Schrappe M, Reiter A, Ludwig WD, et al: Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: Results of trial ALL-BFM 90—German-Austrian-Swiss ALL-BFM Study Group. Blood 95:3310,2000-3322,

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