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Acute Leukemias

Factors influencing survival after relapse from acute lymphoblastic leukemia: a Children's Oncology Group study

Leukemia volume 22, pages 2142–2150 (2008)Cite this article

Abstract

Despite great progress in curing childhood acute lymphoblastic leukemia (ALL), survival after relapse remains poor. We analyzed survival after relapse among 9585 pediatric patients enrolled on Children's Oncology Group clinical trials between 1988 and 2002. A total of 1961 patients (20.5%) experienced relapse at any site. The primary end point was survival. Patients were subcategorized by the site of relapse and timing of relapse from initial diagnosis. Time to relapse remains the strongest predictor of survival. Patients experiencing early relapse less than 18 months from initial diagnosis had a particularly poor outcome with a 5-year survival estimate of 21.0±1.8%. Standard risk patients who relapsed had improved survival compared with their higher risk counterparts; differences in survival for the two risk groups was most pronounced for patients relapsing after 18 months. Adjusting for both time and relapse site, multivariate analysis showed that age (10+ years) and the presence of central nervous system disease at diagnosis, male gender, and T-cell disease were significant predictors of inferior post-relapse survival. It can be noted that there was no difference in survival rates for relapsed patients in earlier vs later era trials. New therapeutic strategies are urgently needed for children with relapsed ALL and efforts should focus on discovering the biological pathways that mediate drug resistance.

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Acknowledgements

This work has been sponsored by the Doris Duke Charitable Foundation (KN), NIH K22 CA113557, The Leukemia Lymphoma Society (LLS 2157-08), and the Frank Campini Foundation (MLL), NIH U10 CA98543-01 (ML, EAR, HS, WLC, NJW, SPH, PSG, and MLL). Dr Loh is a Clinical Scholar of the Leukemia Lymphoma Society.

Author information

Authors and Affiliations

  1. Mayo Medical School, Rochester, MN, USA

    K Nguyen

  2. Department of Epidemiology and Health Policy Research, Children's Oncology Group, University of Florida, Gainesville, FL, USA

    M Devidas

  3. Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA

    S-C Cheng

  4. Department of Biostatistics, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA

    M La

  5. Department of Pediatrics, New York University Cancer Institute, New York University School of Medicine, New York, NY, USA

    E A Raetz & W L Carroll

  6. Department of Pediatrics, University of Texas Southwestern School of Medicine, Dallas, TX, USA

    N J Winick

  7. Department of Pediatrics, University of Colorado Denver and The Children's Hospital, Aurora, CO, USA

    S P Hunger

  8. Department of Hematology-Oncology, Childrens Hospital, Los Angeles, CA, USA

    P S Gaynon

  9. Department of Pediatrics, University of California San Francisco Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA

    M L Loh

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Correspondence to M L Loh.

Additional information

This paper was accepted for poster presentation at the American Society of Hematology 48th annual meeting on 9–12 December 2006 as Abstract 1855.

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Nguyen, K., Devidas, M., Cheng, SC. et al. Factors influencing survival after relapse from acute lymphoblastic leukemia: a Children's Oncology Group study. Leukemia 22, 2142–2150 (2008). https://doi.org/10.1038/leu.2008.251

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