Risk- and response-based classification of childhood B-precursor acute lymphoblastic leukemia

A combined analysis of prognostic markers from the Pediatric Oncology Group (POG) and Children's Cancer Group (CCG)

Kirk R. Schultz, D. Jeanette Pullen, Harland N. Sather, Jonathan J. Shuster, Meenakshi Devidas, Michael J Borowitz, Andrew J. Carroll, Nyla A. Heerema, Jeffrey E. Rubnitz, Mignon L. Loh, Elizabeth A. Raetz, Naomi J. Winick, Stephen P. Hunger, William L. Carroll, Paul S. Gaynon, Bruce M. Camitta

Research output: Contribution to journalArticle

Abstract

The Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG) joined to form the Children's Oncology Group (COG) in 2000. This merger allowed analysis of clinical, biologic, and early response data predictive of event-free survival (EFS) in acute lymphoblastic leukemia (ALL) to develop a new classification system and treatment algorithm. From 11 779 children (age, 1 to 21.99 years) with newly diagnosed B-precursor ALL consecutively enrolled by the CCG (December 1988 to August 1995, n = 4986) and POG (January 1986 to November 1999, n = 6793), we retrospectively analyzed 6238 patients (CCG, 1182; POG, 5056) with informative cytogenetic data. Four risk groups were defined as very high risk (VHR; 5-year EFS, 45% or below), lower risk (5-year EFS, at least 85%), and standard and high risk (those remaining in the respective National Cancer Institute [NCI] risk groups). VHR criteria included extreme hypodiploidy (fewer than 44 chromosomes), t(9;22) and/or BCR/ABL, and induction failure. Lower-risk patients were NCI standard risk with either t(12;21) (TEL/AML1) or simultaneous trisomies of chromosomes 4, 10, and 17. Even with treatment differences, there was high concordance between the CCG and POG analyses. The COG risk classification scheme is being used for division of B-precursor ALL into lower- (27%), standard- (32%), high- (37%), and very-high-(4%) risk groups based on age, white blood cell (WBC) count, cytogenetics, day-14 marrow response, and end induction minimal residual disease (MRD) by flow cytometry in COG trials.

Original languageEnglish (US)
Pages (from-to)926-935
Number of pages10
JournalBlood
Volume109
Issue number3
DOIs
StatePublished - Feb 1 2007

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Pediatrics
Oncology
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Neoplasms
Disease-Free Survival
National Cancer Institute (U.S.)
Chromosomes
Cytogenetics
Chromosomes, Human, Pair 10
Chromosomes, Human, Pair 9
Chromosomes, Human, Pair 17
Chromosomes, Human, Pair 4
Flow cytometry
Trisomy
Residual Neoplasm
Leukocyte Count
Flow Cytometry
Blood
Bone Marrow
Cells

ASJC Scopus subject areas

  • Hematology

Cite this

Risk- and response-based classification of childhood B-precursor acute lymphoblastic leukemia : A combined analysis of prognostic markers from the Pediatric Oncology Group (POG) and Children's Cancer Group (CCG). / Schultz, Kirk R.; Pullen, D. Jeanette; Sather, Harland N.; Shuster, Jonathan J.; Devidas, Meenakshi; Borowitz, Michael J; Carroll, Andrew J.; Heerema, Nyla A.; Rubnitz, Jeffrey E.; Loh, Mignon L.; Raetz, Elizabeth A.; Winick, Naomi J.; Hunger, Stephen P.; Carroll, William L.; Gaynon, Paul S.; Camitta, Bruce M.

In: Blood, Vol. 109, No. 3, 01.02.2007, p. 926-935.

Research output: Contribution to journalArticle

Schultz, KR, Pullen, DJ, Sather, HN, Shuster, JJ, Devidas, M, Borowitz, MJ, Carroll, AJ, Heerema, NA, Rubnitz, JE, Loh, ML, Raetz, EA, Winick, NJ, Hunger, SP, Carroll, WL, Gaynon, PS & Camitta, BM 2007, 'Risk- and response-based classification of childhood B-precursor acute lymphoblastic leukemia: A combined analysis of prognostic markers from the Pediatric Oncology Group (POG) and Children's Cancer Group (CCG)', Blood, vol. 109, no. 3, pp. 926-935. https://doi.org/10.1182/blood-2006-01-024729
Schultz, Kirk R. ; Pullen, D. Jeanette ; Sather, Harland N. ; Shuster, Jonathan J. ; Devidas, Meenakshi ; Borowitz, Michael J ; Carroll, Andrew J. ; Heerema, Nyla A. ; Rubnitz, Jeffrey E. ; Loh, Mignon L. ; Raetz, Elizabeth A. ; Winick, Naomi J. ; Hunger, Stephen P. ; Carroll, William L. ; Gaynon, Paul S. ; Camitta, Bruce M. / Risk- and response-based classification of childhood B-precursor acute lymphoblastic leukemia : A combined analysis of prognostic markers from the Pediatric Oncology Group (POG) and Children's Cancer Group (CCG). In: Blood. 2007 ; Vol. 109, No. 3. pp. 926-935.
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abstract = "The Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG) joined to form the Children's Oncology Group (COG) in 2000. This merger allowed analysis of clinical, biologic, and early response data predictive of event-free survival (EFS) in acute lymphoblastic leukemia (ALL) to develop a new classification system and treatment algorithm. From 11 779 children (age, 1 to 21.99 years) with newly diagnosed B-precursor ALL consecutively enrolled by the CCG (December 1988 to August 1995, n = 4986) and POG (January 1986 to November 1999, n = 6793), we retrospectively analyzed 6238 patients (CCG, 1182; POG, 5056) with informative cytogenetic data. Four risk groups were defined as very high risk (VHR; 5-year EFS, 45{\%} or below), lower risk (5-year EFS, at least 85{\%}), and standard and high risk (those remaining in the respective National Cancer Institute [NCI] risk groups). VHR criteria included extreme hypodiploidy (fewer than 44 chromosomes), t(9;22) and/or BCR/ABL, and induction failure. Lower-risk patients were NCI standard risk with either t(12;21) (TEL/AML1) or simultaneous trisomies of chromosomes 4, 10, and 17. Even with treatment differences, there was high concordance between the CCG and POG analyses. The COG risk classification scheme is being used for division of B-precursor ALL into lower- (27{\%}), standard- (32{\%}), high- (37{\%}), and very-high-(4{\%}) risk groups based on age, white blood cell (WBC) count, cytogenetics, day-14 marrow response, and end induction minimal residual disease (MRD) by flow cytometry in COG trials.",
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