open access
Changing risk factors in childhood acute lymphoblastic leukemia: experience from Kujawsko-Pomorski region 1976–2018
Affiliations- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Toruń, Jurasz University Hospital 1, Bydgoszcz, Poland
open access
Abstract
Introduction: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. Risk factors in childhood ALL have changed during recent decades, mostly due to treatment personalization.
The aim of this study was to analyze therapy results and prognostic factors in childhood ALL in the Kujawsko-Pomorski region of Poland between 1976 and 2018.
Material and methods: Data from 495 patients (0–18 years old) diagnosed with ALL from the Kujawsko-Pomorski region between 1976 and 2018 was analyzed. Prognostic factors were analyzed separately in specific therapeutic groups, which were defined by several therapy protocols.
Results: Prognostic factors have changed over the course of consecutive therapeutic periods. Between 1976 and 1988 (the first and second therapeutic protocols), central nervous system involvement was the most important risk factor. During the third therapeutic period, an unsatisfactory treatment response on days 8 and 14 was related to a poor outcome. In 1995–2002, the risk factors were hepatomegaly, splenomegaly, lymph nodes involvement, and unsatisfactory therapy response on days 15 and 33. Between 2002 and 2011, immunophenotype other than ‘common’ and hemoglobin level at diagnosis were the risk factors, and a lack of BCR-ABL aberration was related to better therapy results. During the final analyzed period (2011–2018), failure to achieve remission on day 33 was a risk factor, and patients classified as non-high risk group and those aged <6 years had better outcomes.
Conclusions: The changing profile of risk factors in ALL has reflected progress in ALL therapy, with the gradual elimination of factors related to poor outcomes, mostly due to modifications in treatment and the development of diagnostic methods as well as therapy monitoring.
Abstract
Introduction: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. Risk factors in childhood ALL have changed during recent decades, mostly due to treatment personalization.
The aim of this study was to analyze therapy results and prognostic factors in childhood ALL in the Kujawsko-Pomorski region of Poland between 1976 and 2018.
Material and methods: Data from 495 patients (0–18 years old) diagnosed with ALL from the Kujawsko-Pomorski region between 1976 and 2018 was analyzed. Prognostic factors were analyzed separately in specific therapeutic groups, which were defined by several therapy protocols.
Results: Prognostic factors have changed over the course of consecutive therapeutic periods. Between 1976 and 1988 (the first and second therapeutic protocols), central nervous system involvement was the most important risk factor. During the third therapeutic period, an unsatisfactory treatment response on days 8 and 14 was related to a poor outcome. In 1995–2002, the risk factors were hepatomegaly, splenomegaly, lymph nodes involvement, and unsatisfactory therapy response on days 15 and 33. Between 2002 and 2011, immunophenotype other than ‘common’ and hemoglobin level at diagnosis were the risk factors, and a lack of BCR-ABL aberration was related to better therapy results. During the final analyzed period (2011–2018), failure to achieve remission on day 33 was a risk factor, and patients classified as non-high risk group and those aged <6 years had better outcomes.
Conclusions: The changing profile of risk factors in ALL has reflected progress in ALL therapy, with the gradual elimination of factors related to poor outcomes, mostly due to modifications in treatment and the development of diagnostic methods as well as therapy monitoring.
Keywords
acute lymphoblastic leukemia, prognostic factors, risk factors, children, therapeutic era
About this articleTitle
Changing risk factors in childhood acute lymphoblastic leukemia: experience from Kujawsko-Pomorski region 1976–2018
Journal
Issue
Article type
Original research article
Pages
11-17
Published online
2023-01-27
Page views
304
Article views/downloads
38
DOI
10.5603/AHP.a2023.0003
Bibliographic record
Acta Haematol Pol 2023;54(1):11-17.
Keywords
acute lymphoblastic leukemia
prognostic factors
risk factors
children
therapeutic era
Authors
Joanna Stankiewicz
Ewa Demidowicz
Agnieszka Jatczak-Gaca
Natalia Bartoszewicz
Andrzej Kołtan
Sylwia Kołtan
Krzysztof Czyżewski
Monika Richert-Przygońska
Robert Dębski
Monika Pogorzała
Barbara Tejza
Piotr Księżniakiewicz
Joanna Cisek
Marlena Ewertowska
Agata Marjańska
Anna Dąbrowska
Anna Urbańczyk
Elżbieta Grześk
Kamila Jaremek
Eugenia Winogrodzka
Dominika Kołuda
Monika Łęcka
Monika Adamkiewicz
Sandra Wałach
Oliwia Grochowska
Sonia Tarasenko
Marta Mazalon
Magdalena Dziedzic
Małgorzata Kubicka
Beata Kuryło-Rafińska
Ewa Dembna
Agnieszka Majk
Mariusz Wysocki
Jan Styczyński
References (22)- Styczyński J, Balwierz W, Dembowska-Bagińska B, et al. Paediatric oncology and haematology in Poland: position paper. Pediatr Pol. 2018; 93(6): 451–461.
- Vrooman LM, Silverman LB. Treatment of childhood acute lymphoblastic leukemia: prognostic factors and clinical advances. Curr Hematol Malig Rep. 2016; 11(5): 385–394.
- Malard F, Mohty M. Acute lymphoblastic leukaemia. Lancet. 2020; 395(10230): 1146–1162.
- Vrooman LM, Silverman LB. Childhood acute lymphoblastic leukemia: update on prognostic factors. Curr Opin Pediatr. 2009; 21(1): 1–8.
- Jatczak-Gaca A, Styczyński J, Kołtan A, et al. Analiza czynników prognostycznych w ostrej białaczce limfoblastycznej u dzieci leczonych w regionie kujawsko-pomorskim w latach 1976–2010. Post Nauk Med. 26; 9(201): 627–633.
- Rivera GK, Pinkel D, Simone JV, et al. Treatment of acute lymphoblastic leukemia. 30 years' experience at St. Jude Children's Research Hospital. N Engl J Med. 1993; 329(18): 1289–1295.
- Möricke A, Zimmermann M, Reiter A, et al. Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000. Leukemia. 2010; 24(2): 265–284.
- Gustafsson G, Schmiegelow K, Forestier E, et al. Improving outcome through two decades in childhood ALL in the Nordic countries: the impact of high-dose methotrexate in the reduction of CNS irradiation. Nordic Society of Pediatric Haematology and Oncology (NOPHO). Leukemia. 2000; 14(12): 2267–2275.
- Kwiecińska K, Balwierz W, Moryl-Bujakowska A, et al. [Long-term observations of children with acute lymphoblastic leukemia and high leukocytosis treated according to modified "New York" protocols (1987-2003)]. Przegl Lek. 2010; 67(6): 350–354.
- Stary J, Zimmermann M, Campbell M, et al. Intensive chemotherapy for childhood acute lymphoblastic leukemia: results of the randomized intercontinental trial ALL IC-BFM 2002. J Clin Oncol. 2014; 32(3): 174–184.
- Zawitkowska J, Lejman M, Zaucha-Prażmo A, et al. Clinical characteristics and analysis of treatment result in children with Ph-positive acute lymphoblastic leukaemia in Poland between 2005 and 2017. Eur J Haematol. 2018; 101(4): 542–548.
- Lee JW, Cho B. Prognostic factors and treatment of pediatric acute lymphoblastic leukemia. Korean J Pediatr. 2017; 60(5): 129–137.
- Council MR. Treatment of acute lymphoblastic leukaemia — effect of “prophylactic” therapy against central nervous system leukaemia. Br Med J. 1973; 2: 381–384.
- Kotecha RS, Gottardo NG, Kees UR, et al. The evolution of clinical trials for infant acute lymphoblastic leukemia. Blood Cancer J. 2014; 4(4): e200.
- Schrappe M, Reiter A, Ludwig WD, et al. Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: results of trial ALL-BFM 90. German-Austrian-Swiss ALL-BFM Study Group. Blood. 2000; 95(11): 3310–3322.
- Gao J, Liu WJ. Prognostic value of the response to prednisone for children with acute lymphoblastic leukemia: a meta-analysis. Eur Rev Med Pharmacol Sci. 2018; 22(22): 7858–7866.
- Puła A, Zdunek M, Michalczyk K, et al. Chemotherapy delays in children with acute lymphoblastic leukemia might influence the outcome of treatment. Acta Haematol Pol. 2022; 53(2): 141–148.
- Aricò M, Valsecchi MG, Conter V, et al. Improved outcome in high-risk childhood acute lymphoblastic leukemia defined by prednisone-poor response treated with double Berlin-Frankfurt-Muenster protocol II. Blood. 2002; 100(2): 420–426.
- Attarbaschi A, Mann G, Zimmermann M, et al. on behalf of the AIEOP-BFM (Associazione Italiana di Ematologia e Oncologia Pediatrica & Berlin-Frankfurt-Münster) Study Group. Randomized post-induction and delayed intensification therapy in high-risk pediatric acute lymphoblastic leukemia: long-term results of the international AIEOP-BFM ALL 2000 trial. Leukemia. 2020; 34(6): 1694–1700.
- Health Quality Ontario. Minimal residual disease evaluation in childhood acute lymphoblasticleukemia: a clinical evidence review. Ont Health Technol Assess Ser. 2016; 16(7): 1–52.
- Cario G, Leoni V, Conter V, et al. BCR-ABL1-like acute lymphoblastic leukemia in childhood and targeted therapy. Haematologica. 2020; 105(9): 2200–2204.
- Styczyński J. A brief history of CAR-T cells: from laboratory to the bedside. Acta Haematol Pol. 2020; 51(1): 2–5.