hematology
Contributions
Type: Publication Only
Background
More than 80% of children with acute lymphoblastic leukemia (ALL) can be cured, but subsets of patients have significantly worse outcomes. In this study we analyzed the clinical, biological features and therapeutic results of patients treated with high risk group of the EORTC protocol.
Aims
Report the outcome of high risk childhood acute lymphoblastic leukemia group
Methods
From January 2000 to December 2013, 160 patients with ALL aged less than 16 years were treated by the EORTC protocol in the Hematologic department of Hedi Chaker Hospital, from those 37 patients were treated by high risk group (VHR). The VHR group includes patients with poor prednisone response at day 8 (more than 1000 blasts/mm3 on the blood smear), those with defavorable cytogenetic abnormalities (t (9,22), t (4,11)...) and those with complete remission after two courses of chemotherapy. From those patients we analyzed the clinical and biological features (Age, sex, blood count, cytogenetic abnormalities and blasts phenotypes) and therapeutic results (remission rate, rate relapse, overall survival (OS), event free survival (EFS) and disease free survival (DFS) at 5 years follow up).
Results
In our study, thirty seven children were treated with VHR group of the EORTC protocol (23%). The median age of patients was 9 years (ranged 2-15 years). Sex ratio H/F=1,64. The median WBC count at diagnosis was 55.8 G/L (ranged from 2 to 400 G/L). There were 51% with B-cell ALL and 49% with T-cell ALL. Cortico-resistance was the only high risk factor in 23 patients, absence the remission after induction in 8 patients and only cytogenetic abnormalities in 4 patients. The cortico-resistance at day 8 was observed in 65% of patients. Five children (13.5%) were treatment failure after two courses of chemotherapy. The complete remission was obtained in 32 children (86%), among them 12 relapsed (37.5%). The post induction death was noted in 2 patients. Only 7 patients (16%) underwent allograft from familial donor. At 5 years follow-up, the OS, EFS and DFS were respectively 46%, 43% and 54%.
Summary
The frequency of high risk group in our study is more than those observed in the literature (12 to 16%). The poor 5 years survivals (OS=46%, EFS=43%) are related to the high rate of relapse. Improvement of outcome can be obtained by enlargement of donor source: unrelated and cord blood.
Keyword(s): Acute lymphoblastic leukemia, Childhood
Type: Publication Only
Background
More than 80% of children with acute lymphoblastic leukemia (ALL) can be cured, but subsets of patients have significantly worse outcomes. In this study we analyzed the clinical, biological features and therapeutic results of patients treated with high risk group of the EORTC protocol.
Aims
Report the outcome of high risk childhood acute lymphoblastic leukemia group
Methods
From January 2000 to December 2013, 160 patients with ALL aged less than 16 years were treated by the EORTC protocol in the Hematologic department of Hedi Chaker Hospital, from those 37 patients were treated by high risk group (VHR). The VHR group includes patients with poor prednisone response at day 8 (more than 1000 blasts/mm3 on the blood smear), those with defavorable cytogenetic abnormalities (t (9,22), t (4,11)...) and those with complete remission after two courses of chemotherapy. From those patients we analyzed the clinical and biological features (Age, sex, blood count, cytogenetic abnormalities and blasts phenotypes) and therapeutic results (remission rate, rate relapse, overall survival (OS), event free survival (EFS) and disease free survival (DFS) at 5 years follow up).
Results
In our study, thirty seven children were treated with VHR group of the EORTC protocol (23%). The median age of patients was 9 years (ranged 2-15 years). Sex ratio H/F=1,64. The median WBC count at diagnosis was 55.8 G/L (ranged from 2 to 400 G/L). There were 51% with B-cell ALL and 49% with T-cell ALL. Cortico-resistance was the only high risk factor in 23 patients, absence the remission after induction in 8 patients and only cytogenetic abnormalities in 4 patients. The cortico-resistance at day 8 was observed in 65% of patients. Five children (13.5%) were treatment failure after two courses of chemotherapy. The complete remission was obtained in 32 children (86%), among them 12 relapsed (37.5%). The post induction death was noted in 2 patients. Only 7 patients (16%) underwent allograft from familial donor. At 5 years follow-up, the OS, EFS and DFS were respectively 46%, 43% and 54%.
Summary
The frequency of high risk group in our study is more than those observed in the literature (12 to 16%). The poor 5 years survivals (OS=46%, EFS=43%) are related to the high rate of relapse. Improvement of outcome can be obtained by enlargement of donor source: unrelated and cord blood.
Keyword(s): Acute lymphoblastic leukemia, Childhood