Ploidy of lymphoblasts is the strongest predictor of treatment outcome in b-progenitor cell acute lymphoblastic leukemia of childhood: A pediatric oncology group study

R. Trueworthy, J. Shuster, T. Look, W. Crist, M. Borowitz, A. Carroll, L. Frankel, M. Harris, H. Wagner, M. Haggard, A. Mosijczuk, J. Pullen, P. Steuber, V. Land

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Using the technique of recursive partitioning and amalgamation analysis with verification, the Pediatric Oncology Group (POG) investigated the independent prognostic significance of previously published prognostic factors significantly associated with event-free survival (EFS) in B-progenitor cell acute lymphoblastic leukemia (ALL). Portents and Methods; Age, leukocyte count, sex, immunophenotype (expression of cytoplasmic immunoglobulin [Ig] and of surface antigens CD10 and CD34), and DNA index (ratio of the flow cytometry-determined DNA content of leukemia cells to that of normal diploid cells) were the variables used in the evaluation of four antimetabolite-based chemotherapy regimens in 1,535 children with the newly diagnosed B-progenitor cell ALL between February 1986 and May 1990. Results: There were three subgroups at widely different risks of treatment failure. A DNA index greater than 1.16 was the most prognostic feature. The final prognostic subgrouping was as follows: (1) DNA index greater than 1.16; (2) DNA index ≤ 1.16, age less than 11.0 years, and leukocyte count less than 50 × 10'/L; and (3) DNA index ≤ 1.16, (age greater than 11.0 years, and/or leukocyte count greater than 50 × 10'/L). These groups made up 20%, 53%, and 27% of the patients and had 4-year EFS rates (SE) of 90.1% (6.3%), 80.5% (5.1%), and 50.4% (7.6%), respectively. Conclusions: Use of the DNA index, leukocyte count, and age - data that are relatively inexpensive and simple to obtain - may be sufficient to stratify patients with B-progenitor cell ALL for risk-directed therapy. Patients at an extremely low risk of failing therapy (-20% of cases in this study) can thus be identified and spared the toxic short-term and late effects of more intensive therapies that may be needed for children with less favorable clinical and biologic features.

Original languageEnglish (US)
Pages (from-to)606-613
Number of pages8
JournalJournal of Clinical Oncology
Volume10
Issue number4
DOIs
StatePublished - 1992
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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