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| Original manuscript: clinical laboratory correlates |
| Relation between age, immunophenotype and in vitro drug resistance in 395 children with acute lymphoblastic leukemia-implications for treatment of infants |
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| R Pieters1,a, M L den Boer1, M Durian1, G Janka3, K Schmiegelow4, G J L Kaspers1, E R van Wering2 and A J P Veerman1,2 |
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1University Hospital VU, Dept of Pediatric Hematology/Oncology, Amsterdam, The Netherlands
2Dutch Childhood Leukemia Study Group, The Hague, The Netherlands
3COALL Study Group, Hamburg, Germany
4Dept of Pediatrics, The Juliana Marie Centre, Copenhagen, Denmark
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aCorrespondence: Dr R Pieters, University Hospital VU, Dept of Pediatric Hematology/Oncology, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Fax: 31 20 4442422 |
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| Abstract |
| The prognosis of infant ALL, characterized by a high incidence of the immature CD10 negative B-lineage ALL (proB ALL) is poor. This study aimed to determine the resistance profile of infant ALL cells. In vitro drug resistance was determined by the MTT assay of 395 children with ALL at initial diagnosis: there were 21 infants <1.5 years of which nine <1 year, 284 children aged 1.5-10 years (intermediate age group) and 90 children >10 years. Immunophenotyping resulted in 310 cALL/preB ALL, 69 T-ALL, 15 proB ALL and one unknown cases. The following drugs were tested: daunorubicin, doxorubicin, mitoxantrone, idarubicin (Ida), prednisolone (Pred), dexamethasone (DXM), vincristine (VCR), Asparaginase (Asp), 6-MP, 6-TG, AraC, VM26 and 4-HOO-ifosfamide (Ifos). Infants <1.5 years were significantly more resistant to pred (>500-fold), Asp (11-fold) and VM26 (2.7-fold) but significantly more sensitive to Ara-C (2.3-fold) compared to the intermediate age group. When analyzing infants <1 year of age similar results were found. prob all cells (seven infants <1.5 years; eight children >1.5 years) were significantly more resistant to glucocorticoids, Asp, thiopurines, anthracyclines and Ifos compared to cALL/preB ALL but more sensitive to Ara-C. Cells from children >10 years were significantly more resistant to Pred, DXM, Asp, Ida and 6-MP. T-ALL cells showed a strong resistance to Pred, Asp and VCR and a mild but significant resistance to all other drugs except thiopurines and VM26. We conclude that the poor prognosis of infant ALL is associated with a resistance to glucocorticoids and Asp. However, ALL cells from infants show a relatively high sensitivity to Ara-C which suggests that infants with ALL might benefit from treatment schedules that incorporate more Ara-C than the current treatment protocols. |
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| Keywords |
| acute lymphoblastic leukemia; infant; age; drug resistance; MLL; T-ALL; cytosine arabinoside |
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| Received 11 February 1998; accepted 25 May 1998 |
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| September 1998, Volume 12, Number 9, Pages 1344-1348 |
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