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Prognosis

Slow disappearance of peripheral blood blasts is an adverse prognostic factor in childhood T cell acute lymphoblastic leukemia: a Pediatric Oncology Group study

Leukemia volume 14, pages 792–795 (2000)Cite this article

Abstract

The rapidity of response to induction therapy is emerging as an important prognostic factor in children and adolescents with acute lymphoblastic leukemia (ALL). We studied the relationship between rapidity of reduction in peripheral blood blast count and treatment outcome in children with T cell ALL (T-ALL). Initial systemic chemotherapy included prednisone, vincristine, doxorubicin and cyclophosphamide. A Cox analysis evaluated the correlation between the length of time that the peripheral blood absolute blast count (ABC) remained above 1000/mm3 following the start of treatment and event-free survival (efs). data were available for 281 patients. patients for whom the abc remained >1000/mm3 for 3 or more days following administration of intensive therapy had an estimated 5-year EFS of 34.2% (s.e. = 7.2) vs 58.3% (3.5) for those whose ABC was <1000/mm3 within 0–2 days, with a hazard ratio (HR) of failure of 2.03 (95% CI = 1.35–3.06, P < 0.001) for the slower responding patients. pre-treatment of some type (usually with prednisone) occurred in 128 patients (average duration 1.7 days). when this was accounted for, patients with an abc >1000/mm3 for 5 or more days following the start of treatment of any kind had a HR for failure of 2.27 (95% CI = 1.38–3.72, P < 0.001) compared to those responding within 0–4 days. inclusion of other clinical and biological factors in a multivariate analysis did not alter the prognostic importance of slower blast clearance. pediatric patients with t-all who have a circulating blast count >1000/mm3 at diagnosis and a relatively slower response to initial treatment are at increased risk of treatment failure. Rapidity of response may therefore be a clinically useful prognostic factor for patients with T-ALL.

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Authors and Affiliations

  1. Cook Children's Hematology and Oncology Center, Cook Children's Medical Center, Fort Worth, TX, USA

    TC Griffin

  2. Pediatric Oncology Group Statistical Office, University of Florida, Gainesville, FL, USA

    JJ Shuster

  3. Department of Pediatrics, Division of Hematology/Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA

    GR Buchanan

  4. Department of Pediatrics, Children's Memorial Hospital of Chicago, Chicago, IL, USA

    SB Murphy

  5. Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI, USA

    BM Camitta

  6. Department of Pediatrics, Division of Hematology/Oncology, Stanford University Medical Center, Stanford, CA, USA

    MD Amylon

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Griffin, T., Shuster, J., Buchanan, G. et al. Slow disappearance of peripheral blood blasts is an adverse prognostic factor in childhood T cell acute lymphoblastic leukemia: a Pediatric Oncology Group study. Leukemia 14, 792–795 (2000). https://doi.org/10.1038/sj.leu.2401768

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