Impact of age, leukocyte count and day 21-bone marrow response to chemotherapy on the long-term outcome of children with philadelphia chromosome-positive acute lymphoblastic leukemia in the pre-imatinib era: results of the FRALLE Reportar como inadecuado




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BMC Cancer

, 9:14

First Online: 13 January 2009Received: 15 September 2008Accepted: 13 January 2009DOI: 10.1186-1471-2407-9-14

Cite this article as: Gandemer, V., Auclerc, MF., Perel, Y. et al. BMC Cancer 2009 9: 14. doi:10.1186-1471-2407-9-14

Abstract

BackgroundWe explored the heterogeneity of philadelphia chromosome-positive acute lymphoblastic leukemia Ph1-ALL in a study of the effect of early features on prognosis in children. Here we report the long-term results of the FRALLE 93 study conducted in the era before the use of tyrosine kinase inhibitors.

MethodsBetween 1993 and 1999, 36 children with Ph1-ALL were enrolled into the FRALLE 93 protocol. After conventional four-drug induction, children were stratified by availability of an HLA-matched sibling.

ResultsComplete remission CR was observed in 26 children 72%, of which 13 underwent allogeneic bone marrow transplantation BMT. Thirty-one children were good responders to prednisone, defined on day 8, and 21 were good responders to chemotherapy, defined by day-21 bone marrow M1. Overall five-year disease-free survival DFS was 42 ± 9.7%. Based on multivariate analysis, two groups showed marked differences in five-year outcome: children with age<10, leukocyte count <100,000-mm and day-21 M1 marrow had a more favorable prognosis 14 pts: 100% CR, event free survival EFS: 57%, overall survival OS: 79%, than the high-risk group 22 patients: 55% CR, EFS: 18%, OS: 27% p < 0.005. We also observed a non statistically significant difference p = 0.14 in outcome between these groups for transplanted patients 5-year DFS: 83 ± 14% and 33 ± 15%, respectively.

ConclusionAge, leukocyte count and early response to treatment defined by the D21 bone marrow response provide an accurate model for outcome prediction. The combination of available tools such as minimal residual disease assessment with determination of these simple factors could be useful for refining indications for BMT in the current era of tyrosine-kinase inhibitor-based therapy.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-9-14 contains supplementary material, which is available to authorized users.

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Autor: Virginie Gandemer - Marie-Francoise Auclerc - Yves Perel - Jean-Pierre Vannier - Edouard Le Gall - Francois Demeocq - Claudi

Fuente: https://link.springer.com/







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