Abstract Objective To explore the factors related to prognosis and treatment failure in children with acute lymphoblastic leukemia (ALL). Methods A retrospective study was conducted to collect and analyze clinical data of ALL children admitted to the Department of Pediatric Hematology at Tongji Hospital, Huazhong University of Science and Technology, from January 2012 to December 2019, with follow-up until June 2024. Results A total of 341 children with ALL were included. Among the 69 children with treatment failure, 55 (80%) experienced relapse, while 14 (20%) had non-relapse-related deaths, and no secondary tumors were observed. Initial WBC count ≥50×109/L, positive minimal residual disease, and severe adverse events were identified as independent risk factors for treatment failure (P<0.05). Among the 55 relapsed patients, early relapses were predominant (36%), and the primary site of relapse was the bone marrow (56%). Immunophenotyping (P=0.009), initial WBC count (P=0.011), and fusion genes (P=0.040) were associated with the timing of relapse. High-risk status, T-cell ALL, relapse, and severe adverse events were independent risk factors affecting long-term survival (P<0.05). Conclusions The prognosis of children with ALL is related to risk stratification, immunophenotyping, relapse status, and occurrence of severe adverse events. Among these factors, relapse is the primary cause of treatment failure. Actively preventing relapse may reduce the treatment failure rate and improve long-term survival.
Corresponding Authors:
Zhang A, Email: 1273118539@qq.com
E-mail: 1273118539@qq.com
Cite this article:
YIN Meng-Meng,HU Qun,LIU Ai-Guo et al. Factors associated with prognosis and treatment failure in children with acute lymphoblastic leukemia[J]. CJCP, 2025, 27(3): 308-314.
YIN Meng-Meng,HU Qun,LIU Ai-Guo et al. Factors associated with prognosis and treatment failure in children with acute lymphoblastic leukemia[J]. CJCP, 2025, 27(3): 308-314.
Cai J, Yu J, Zhu X, et al. Treatment abandonment in childhood acute lymphoblastic leukaemia in China: a retrospective cohort study of the Chinese children's cancer group[J]. Arch Dis Child, 2019, 104(6): 522-529. PMID: 30705079. DOI: 10.1136/archdischild-2018-316181.
Saarinen-Pihkala U M, Parto K, Riikonen P, et al. RALLE pilot: response-guided therapy for marrow relapse in acute lymphoblastic leukemia in children[J]. J Pediatr Hematol Oncol, 2012, 34(4): 263-270. PMID: 22246158 DOI: 10.1097/MPH.0b013e3182352da9.
Espinoza D, Blanco Lopez JG, Vasquez R, et al. How should childhood acute lymphoblastic leukemia relapses in low-income and middle-income countries be managed: the AHOPCA-ALL study group experience[J]. Cancer, 2023, 129(5): 771-779. PMID: 36504077. DOI: 10.1002/cncr.34572.
Jiménez-Hernández E, Jaimes-Reyes EZ, Arellano-Galindo J, et al. Survival of Mexican children with acute lymphoblastic leukaemia under treatment with the protocol from the Dana-Farber cancer institute 00-01[J]. Biomed Res Int, 2015, 2015: 576950. PMID: 25922837. PMCID: PMC4398910. DOI: 10.1155/2015/576950.
Lenk L, Alsadeq A, Schewe DM. Involvement of the central nervous system in acute lymphoblastic leukemia: opinions on molecular mechanisms and clinical implications based on recent data[J]. Cancer Metastasis Rev, 2020, 39(1): 173-187. PMID: 31970588. PMCID: PMC7098933. DOI: 10.1007/s10555-020-09848-z.
Schrappe M, Bleckmann K, Zimmermann M, et al. Reduced-intensity delayed intensification in standard-risk pediatric acute lymphoblastic leukemia defined by undetectable minimal residual disease: results of an international randomized trial (AIEOP-BFM ALL 2000)[J]. J Clin Oncol, 2018, 36(3): 244-253. PMID: 29148893. DOI: 10.1200/JCO.2017.74.4946.
Slayton WB, Schultz KR, Silverman LB, et al. How we approach Philadelphia chromosome-positive acute lymphoblastic leukemia in children and young adults[J]. Pediatr Blood Cancer, 2020, 67(10): e28543. PMID: 32779849. DOI: 10.1002/pbc.28543.
