TY - JOUR
T1 - Absolute lymphocyte counts refine minimal residual disease-based risk stratification in childhood acute lymphoblastic leukemia
AU - Rabin, Karen R.
AU - Gramatges, M. Monica
AU - Borowitz, Michael J.
AU - Palla, Shana L.
AU - Shi, Xiaodong
AU - Margolin, Judith F.
AU - Zweidler-McKay, Patrick A.
PY - 2012/9
Y1 - 2012/9
N2 - Background: Several studies have demonstrated the prognostic utility of absolute lymphocyte count (ALC) during therapy for a range of malignancies, with low ALC associated with adverse outcome. Here we investigated whether ALC retained independent prognostic significance with respect to minimal residual disease (MRD) status in children with acute lymphoblastic leukemia (ALL). Procedure: We reviewed 171 cases of pediatric ALL treated on the Children's Oncology Group P9900 series of treatment trials. Variables analyzed included ALC at several time points during Induction, age at diagnosis, cytogenetics, initial white blood cell count, and MRD status at Day 29 of Induction (MRD-29). Results: We found high ALC at Induction Day 29 (ALC-29) to be an independent, clinically significant predictor of improved relapse-free and overall survival (OS). Patients with ALC-29 >1,500cells/μl had a superior 6-year relapse-free survival (80±4% vs. 62±8%, P=0.018) and overall survival (96±2% vs. 74±8%, P=0.001). Moreover, ALC-29 identified distinct prognostic subgroups within cases stratified by MRD-29. In subjects with >0.01% MRD, ALC-29 > or <1,500cells/μl had a significant 51% difference in 6-year OS (92±7% vs. 41±16%, P=0.0001). Conclusions: ALC, a readily obtainable test, constitutes a significant and independent prognostic factor in childhood ALL that may refine current MRD-based risk stratification algorithms and provide key prognostic information in settings where MRD determination is not feasible.
AB - Background: Several studies have demonstrated the prognostic utility of absolute lymphocyte count (ALC) during therapy for a range of malignancies, with low ALC associated with adverse outcome. Here we investigated whether ALC retained independent prognostic significance with respect to minimal residual disease (MRD) status in children with acute lymphoblastic leukemia (ALL). Procedure: We reviewed 171 cases of pediatric ALL treated on the Children's Oncology Group P9900 series of treatment trials. Variables analyzed included ALC at several time points during Induction, age at diagnosis, cytogenetics, initial white blood cell count, and MRD status at Day 29 of Induction (MRD-29). Results: We found high ALC at Induction Day 29 (ALC-29) to be an independent, clinically significant predictor of improved relapse-free and overall survival (OS). Patients with ALC-29 >1,500cells/μl had a superior 6-year relapse-free survival (80±4% vs. 62±8%, P=0.018) and overall survival (96±2% vs. 74±8%, P=0.001). Moreover, ALC-29 identified distinct prognostic subgroups within cases stratified by MRD-29. In subjects with >0.01% MRD, ALC-29 > or <1,500cells/μl had a significant 51% difference in 6-year OS (92±7% vs. 41±16%, P=0.0001). Conclusions: ALC, a readily obtainable test, constitutes a significant and independent prognostic factor in childhood ALL that may refine current MRD-based risk stratification algorithms and provide key prognostic information in settings where MRD determination is not feasible.
KW - ALL
KW - Immunology
KW - Minimal residual disease
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U2 - 10.1002/pbc.23395
DO - 10.1002/pbc.23395
M3 - Article
C2 - 22102553
AN - SCOPUS:84862127741
SN - 1545-5009
VL - 59
SP - 468
EP - 474
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
IS - 3
ER -