TY - JOUR
T1 - Ploidy of lymphoblasts is the strongest predictor of treatment outcome in b-progenitor cell acute lymphoblastic leukemia of childhood
T2 - A pediatric oncology group study
AU - Trueworthy, R.
AU - Shuster, J.
AU - Look, T.
AU - Crist, W.
AU - Borowitz, M.
AU - Carroll, A.
AU - Frankel, L.
AU - Harris, M.
AU - Wagner, H.
AU - Haggard, M.
AU - Mosijczuk, A.
AU - Pullen, J.
AU - Steuber, P.
AU - Land, V.
PY - 1992
Y1 - 1992
N2 - 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.
AB - 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.
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U2 - 10.1200/JCO.1992.10.4.606
DO - 10.1200/JCO.1992.10.4.606
M3 - Article
C2 - 1548523
AN - SCOPUS:0026518781
SN - 0732-183X
VL - 10
SP - 606
EP - 613
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 4
ER -