In:
British Journal of Haematology, Wiley, Vol. 180, No. 4 ( 2018-02), p. 550-562
Abstract:
To prevent relapse, high risk paediatric acute lymphoblastic leukaemia ( ALL ) is treated very intensively. However, most patients who eventually relapse have standard or medium risk ALL with low minimal residual disease ( MRD ) levels. We analysed recurrent microdeletions and other clinical prognostic factors in a cohort of 475 uniformly treated non‐high risk precursor B‐cell ALL patients with the aim of better predicting relapse and refining risk stratification. Lower relapse‐free survival at 7 years ( RFS ) was associated with IKZF 1 intragenic deletions ( P 〈 0·0001); P2 RY 8 ‐ CRLF 2 gene fusion ( P 〈 0·0004); Day 33 MRD 〉 5 × 10 −5 ( P 〈 0·0001) and High National Cancer Institute ( NCI ) risk ( P 〈 0·0001). We created a predictive model based on a risk score ( RS ) for deletions, MRD and NCI risk, extending from an RS of 0 ( RS 0) for patients with no unfavourable factors to RS 2 + for patients with 2 or 3 high risk factors. RS 0, RS 1, and RS 2 + groups had RFS of 93%, 78% and 49%, respectively, and overall survival ( OS ) of 99%, 91% and 71%. The RS provided greater discrimination than MRD ‐based risk stratification into standard (89% RFS , 96% OS ) and medium risk groups (79% RFS , 91% OS ). We conclude that this RS may enable better early therapeutic stratification and thus improve cure rates for childhood ALL .
Type of Medium:
Online Resource
ISSN:
0007-1048
,
1365-2141
DOI:
10.1111/bjh.2018.180.issue-4
Language:
English
Publisher:
Wiley
Publication Date:
2018
detail.hit.zdb_id:
1475751-5
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