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Prognostic Factors for CNS Control in Children with Acute Lymphoblastic Leukemia Treated Without Cranial Irradiation.

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机构： [1]Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. [2]Children's Hospital of Chongqing Medical University. [3]Department of Pediatric, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology &amp [4] Blood Diseases Hospital, Chinese Academy of Medical Sciences &amp [5] Peking Union Medical College, Tianjin, China, tianjin, China. [4]CHILDREN'S HOSPITAL OF SOOCHOW UNIVERSITY, SUZHOU, China. [5]Sichuan University, Chengdu, China. [6]Department of Hematology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China. [7]Children's Hospital of Nanjing Medical University, Nanjing, China. [8]Jiangxi Provincial Children's Hospital, Nanchang, China. [9]Qilu Hospital of Shandong University, Jinan, China. [10]Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. [11]Children's hospital of Fudan university, Shanghai, Alabama, China. [12]Nanfang Hospital, Southern Medical University, Guangzhou, China. [13]KunMing Children's Hospital, Kunming, China. [14]Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. [15]Second Hospital of Anhui Medical University, Hefei, Alabama, China. [16]Shanghai Children's Hospital, Shanghai Jiao Tong University, shanghai, China. [17]Affiliated Hospital of Qingdao University, Qingdao, China. [18]Hong Kong Children's Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. [19]Xiangya Hospital Central South University, Changsha, China. [20]Xi'an Northwest Women's and Children's Hospital, Xi'an, China. [21]St. Jude Children's Research Hospital, Memphis, Tennessee, United States. [22]Sichuan University. [23]Guangzhou Women and Children's Medical Center, Guangzhou, China. [24]1 Nanfang Hospital, Southern Medical University [27] 2 Nanfang-Chunfu Children's Intitute of Hematilogy &amp [28] Oncology, Taixin Hospital, Dongguan, China, Guangzhou, China. [25]The Chinese University of Hong Kong, Hong Kong, Hong Kong. [26]Tianjin Blood institution, Tianjin, China.

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To identify the prognostic factors that are useful to improve CNS control in children with acute lymphoblastic leukemia (ALL), we analyzed the outcome of 7640 consecutive patients treated on China Children's Cancer Group ALL-2015 protocol between 2015 and 2019. This protocol featured prephase dexamethasone treatment before conventional remission induction and subsequent risk-directed therapy, including 16 to 22 triple intrathecal treatments, without prophylactic cranial irradiation. The 5-year event-free survival was 80.3% (95% CI, 78.9%-81.7%), and overall survival 91.1% (95% CI, 90.1%-92.1%). The cumulative risk of isolated CNS relapse was 1.9% (95% CI, 1.5%-2.3%), and any CNS relapse 2.7% (95% CI, 2.2%-3.2%). The isolated CNS relapse rate was significantly lower in patients with B-ALL than in those with T-ALL (1.6%; 95% CI,1.2%-2.0% vs 4.6%; 95% CI 2.9%-6.3%; P <0.001). Independent risk factors for isolated CNS relapse included male sex (hazard ratio [HR], 1.8; 95% CI, 1.1%-3.0%; P=0.03), the presence of BCR-ABL1 fusion (HR, 3.8; 95% CI, 2.0%-7.3%; P <0.001) in B-ALL, and presenting leukocyte count ≥50×109/L (HR, 4.3; 95% CI, 1.5%-12.2%; P=0.007) in T-ALL. Significantly lower isolated CNS relapse was associated with the use of total intravenous anesthesia during intrathecal therapy (HR, 0.2; 95% CI, 0.04%-0.7%; P=0.02) and flow cytometry examination of diagnostic cerebrospinal fluid (HR, 0.2; 95% CI, 0.06%-0.6%; P=0.006) among patients with B-ALL. Prephase dexamethasone treatment, delayed intrathecal therapy, use of total intravenous anesthesia during intrathecal therapy, and flow cytometry examination of diagnostic cerebrospinal fluid may improve CNS control in childhood ALL. Copyright © 2021 American Society of Hematology.

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大类 | 1 区

医学

小类 | 1 区血液学

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大类 | 1 区

医学

小类 | 1 区血液学

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出版当年[2021]版：

Q1 HEMATOLOGY

最新[2023]版：

Q1 HEMATOLOGY

影响因子： 21.1 最新[2023版] 19.2 最新五年平均 25.669 出版当年[2021版] 22.54 出版当年五年平均 23.629 出版前一年[2020版] 20.3 出版后一年[2022版]

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第一作者机构： [1]Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

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