Abstract：Objective To explore the clinical characteristics and prognosis of children and adolescents over 10 years of age with acute lymphoblastic leukemia (ALL). Methods A total of 86 newly diagnosed ALL children and adolescents over 10 years of age (62 cases of B-ALL and 24 cases of T-ALL) were enrolled. Clinical characteristics, therapeutic effect and prognostic factors were retrospectively analyzed. Event-free survival (EFS) and overall survival (OS) rates were estimated by the Kaplan-Meier method. Prognostic factors were evaluated by COX regression analysis. Results Of 86 patients, 62 were in medium risk, and 24 in high risk. At diagnosis, 53 patients (62%) had hepatomegaly, 50 patients (58%) had splenomegaly, and 46 patients (54%) had lymphoadenopathy. Twenty-nine patients (34%) showed high leukocyte counts (≥ 50×109/L) at diagnosis. The karyotype analysis was performed on 78 patients. The percentage of hyperdiploidy was 19% (15 cases), and that of hypodiploidy was 5% (4 cases). Eleven patients (14%) had abnormalities of chromosome structure. Of them, one patient was Philadelphia chromosome-positive, and another patient had the t (1; 19) chromosomal translocation. Three patients (4%) were positive for TEL/AML1, 3 (4%) were positive for E2A/PBX1, 6 were positive for BCR/ABL (7%), and 4 (5%) were positive for SIL/TAL1. During 4 weeks of induction therapy, 85 patients (99%) achieved complete remission (CR). In 86 patients, the 5-year anticipated EFS and OS were (64±6)% and (75±5)% respectively. The 5-year EFS and OS in the medium risk group were significantly higher than those in the high risk group (P < 0.05). The 5-year EFS in B-ALL patients was significantly higher than that in T-ALL patients (P < 0.05). COX multivariate analysis showed that white blood counts at diagnosis and minimal residual disease (MRD) after induction therapy were independent prognostic factors. Conclusions Children and adolescents with ALL over 10 years of age often have clinical characteristics of unfavorable prognosis. White blood counts at diagnosis and MRD after induction therapy may be important factors for the long-term prognosis.
WU Jun,LU Ai-Dong,ZHANG Le-Ping. Clinical characteristics and prognostic analysis of children and adolescents over 10 years of age with acute lymphoblastic leukemia[J]. CJCP, 2017, 19(6): 614-619.
Pui CH, Campana D, Pei D, et al. Treatment of childhood acute lymphoblastic leukemia without prophylactic cranial irradiation[J]. N Engl J Med, 2009, 360(26):2730-2741.
[2]
Lustosa de Sousa DW, de Almeida Ferreira FV, Cavalcante Félix FH, et al. Acute lymphoblastic leukemia in children and adolescents:prognostic factors and analysis of survival[J]. Rev Bras Hematol Hemoter, 2015, 371(4):223-229.
Schultz KR, Bowman WP, Aledo A, et al. Improved early event-free survival with imatinib in Philadelphia chromosome-positive acute lymphoblastic leukemia:a children's oncology group study[J]. J Clin Oncol, 2009, 27(31):5175-5181.
Holt BVD, Dekker AW, Berg AD, et al. Significant difference in outcome for adolescents with acute lymphoblastic leukemia treated on pediatric vs adult protocols in the Netherlands[J]. Leukemia, 2003, 18(12):2032-2035.
[9]
Bolssel N, Auclerc MF, Lhéritier V, et a1. Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 Trials[J]. J Clin Oncol, 2003, 21(5):774-780.
[10]
Hallböök H, Gustafsson G, Smedmyr B, et al. Treatment outcome in young adults and children >10 years of age with acute lymphoblastic leukemia in Sweden:a comparison between a pediatric protocol and an adult protocol[J]. Cancer, 2006, 107(7):1551-1561.
[11]
Stock W, La M, Sanford B, et a1. What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children's Cancer Group and Cancer and Leukemia Group B studies[J]. Blood, 2008, 112(5):1646-1654.
[12]
Pui CH, Pei D, Campana D, et al. Improved prognosis for older adolescents with acute lymphoblastic leukemia[J]. J Clin Oncol, 2011, 29(4):386-391.
Lukenbill J, Advani AS. The treatment of adolescents and young adults with acute lymphoblastic leukemia[J]. Curr Hematol Malig Rep, 2013, 8(2):91-97.
[17]
Gatta G, Rossi S, Foschi R, et al. Survival and cure trends for European children, adolescents and young adults diagnosed with acute lymphoblastic leukemia from 1982 to 2002[J]. Haematologica, 2013, 98(5):744-752.
[18]
Hochberg J, Khaled S, Forman SJ, et al. Criteria for and outcomes of allogeneic haematopoietic stem cell transplant in children, adolescents and young adults with acute lymphoblastic leukaemia in first complete remission[J]. Br J Haematol, 2013, 161(1):27-42.
[19]
Dores GM, Devesa SS, Curtis RE, et al. Acute leukemia incidence and patient survival among children and adults in the United States, 2001-2007[J]. Blood, 2012, 119(1):34-43.
[20]
Conter V, Bartram CR, Valsecchi MG, et al. Molecular response to treatment redefines all prognostic factors in children and adolescents with B-cell precursor acute lymphoblastic leukemia:Results in 3184 patients of the AIEOP-BFM ALL 2000 study[J]. Blood, 2010, 115(16):3206-3214.
[21]
Burke MJ, Gossai N, Wagner JE, et al. Survival differences between adolescent/young adults and children with B-precursor acute lymphoblastic leukemia following allogeneic hematopoietic cell transplantation[J]. Biol Blood Marrow Transplant, 2013, 19(1):138-142.
[22]
Wood WA, Lee SJ, Brazauskas R, et al. Survival improvements in adolescents and young adults after myeloablative allogeneic transplantation for acute lymphoblastic leukemia[J]. Biol Blood Marrow Transplant, 2014, 20(6):829-836.
