Outcome and Prognostic Factors in Pediatric Precursor T-Cell Acute Lymphoblastic Leukemia: A Single-Center Experience.
10.15264/cpho.2018.25.2.116
- Author:
Eun Sang RHEE
1
;
Hyery KIM
;
Sung Han KANG
;
Jae Won YOO
;
Kyung Nam KOH
;
Ho Joon IM
;
Jong Jin SEO
Author Information
1. Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. taban@hanmail.net
- Publication Type:Multicenter Study ; Original Article
- Keywords:
Acute lymphoblastic leukemia;
Pediatric;
Precursor T-cell lymphoblastic leukemia-lymphoma;
Survival
- MeSH:
B-Lymphocytes;
Chungcheongnam-do;
Cranial Irradiation;
Diagnosis;
Disease-Free Survival;
Drug Therapy;
Female;
Humans;
Male;
Medical Records;
Precursor Cell Lymphoblastic Leukemia-Lymphoma*;
Precursor Cells, T-Lymphoid;
Precursor T-Cell Lymphoblastic Leukemia-Lymphoma;
Prognosis;
T-Lymphocytes*
- From:Clinical Pediatric Hematology-Oncology
2018;25(2):116-127
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Precursor T-cell acute lymphoblastic leukemia (T-ALL) has worse prognosis than B-cell ALL. We aimed to evaluate prognostic variables in pediatric T-ALL. METHODS: Medical records of 36 T-ALL patients (27 males and 9 females; median age at diagnosis, 10.6 years) diagnosed and treated at Asan Medical Center from 2001 to 2017 were reviewed. Six patients (16.7%) had early T-cell precursor ALL (ETP-ALL). Most patients received the Children's Cancer Group-1882 (CCG1882) or Korean multicenter high risk ALL (ALL0601) protocols and prophylactic cranial irradiation. Clinical features at presentation, response to therapy, and treatment outcomes were analyzed. RESULTS: The six patients with ETP-ALL and 17 of 30 with non-ETP-ALL received CCG1882 or ALL0601 chemotherapy. Three patients, including two with ETP-ALL, did not achieve complete remission after induction. Rapid early response during induction was achieved by 26 patients. Five year overall survival (OS) and event free survival (EFS) rates were 71.4% and 70.2%, respectively. ETP-ALL and slow early response during induction were significant adverse prognostic factors, while hyperleukocytosis at diagnosis was not. CCG1882/ALL0601 chemotherapy resulted in superior survival (OS: 78.9%, EFS: 73.3%) compared with CCG1901 chemotherapy (OS: 64.3%, EFS: 64.3%), and patients undergoing prophylactic cranial irradiation had superior EFS to non-radiated patients. CONCLUSION: A high risk ALL protocol with intensified post-remission therapy, including prophylactic cranial irradiation, conferred T-ALL survival outcomes comparable with those of Western studies. Further treatment intensification should be considered for patients with ETP-ALL and slow induction responders. Additionally, CNS-directed treatment intensification, without prophylactic cranial irradiation, is needed.
