Outcomes of children treated for relapsed or refractory acute lymphoblastic leukemia: A single tertiary care center experience

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-07-25 DOI:10.1002/cnr2.2117

Mosfer AlMalki, Mohammed Abdulatef, Hassan Altrabolsi, Nasser Shubayr

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Abstract

Background

Acute lymphoblastic leukemia (ALL) is one of the most common malignancies among children. Despite success in frontline treatment, 20% of children will relapse or show resistance to treatment.

Aim

The aim of this study is to evaluate the clinical characteristics of children diagnosed and treated for refractory or relapsed ALL and determine 3-year overall survival (OS) outcomes.

Method

This study involved a retrospective chart review of patients aged 1–14 years diagnosed with ALL during January 2002 to December 2018. Data were extracted for baseline characteristics at diagnosis and at relapse.

Results

A total of 347 newly diagnosed children with ALL were identified, among whom there were three induction failures (IF) and 28 relapses, resulting in a cohort of 31 patients with a relapse rate of 9%. The male-to-female ratio was 4.16:1, and the mean duration of first complete remission (CR1) was 26 months. Fifteen (48%) patients relapsed ≤18 months, 7 (23%) during 18–36 months, and 9 (29%) relapsed >36 months of IF or CR1. Nineteen patients (61%) had isolated bone marrow (BM) relapse, 7 (23%) patients experienced isolated extramedullary relapse (5 isolated CNS relapse and 2 isolated testicular relapse), and 5 (16%) patients experienced BM involvement with other sites (4 BM + CNS and 1 BM + testis). The 3-year OS of the cohort was 62.3%, while in patients with CR post first-salvage therapy, a 3-year OS of 79.5% was observed (p value <.05 compared with patients who did not achieve remission post first-salvage therapy, 3-year OS: 46.4%). The same statistical difference was observed in 3-year OS when comparing the duration of remission of CR prior to relapse: ≤18 months, 33.2%; 18–36 months, 66.7%; and >36 months, 87.5%. The same trend continued when comparing 3-year OS based on risk stratification at relapse: low risk (LR), 83.3%; intermediate risk (IR), 80%; and high risk (HR), 44.8%.

Conclusion

The incidence and outcomes reported are comparable to internationally reported data regarding the duration of CR1. Risk stratification at relapse and remission status post-salvage therapy were identified as significant prognostic factors for survival. No survival difference was observed among patients who received hematopoietic stem cell transplantation after induction compared with those who received chemotherapy, which could be attributed to the smaller sample size, warranting a multi-institutional observational study. These findings corroborate the need for novel therapies and treatment approaches.

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复发或难治性急性淋巴细胞白血病患儿的治疗结果：一家三级医疗中心的经验。

背景：急性淋巴细胞白血病（ALL急性淋巴细胞白血病（ALL）是儿童中最常见的恶性肿瘤之一。目的：本研究旨在评估诊断为难治或复发ALL并接受治疗的儿童的临床特征，并确定3年总生存率（OS）结果：本研究对2002年1月至2018年12月期间确诊为ALL的1-14岁患者进行回顾性病历审查。提取了诊断时和复发时的基线特征数据：共发现347名新确诊的ALL患儿，其中有3例诱导失败（IF）和28例复发，结果有31名患者复发，复发率为9%。男女比例为4.16:1，首次完全缓解（CR1）的平均持续时间为26个月。15名患者（48%）在18个月内复发，7名患者（23%）在18-36个月内复发，9名患者（29%）在IF或CR1超过36个月后复发。19名患者（61%）经历了孤立的骨髓（BM）复发，7名患者（23%）经历了孤立的髓外复发（5名患者经历了孤立的中枢神经系统复发，2名患者经历了孤立的睾丸复发），5名患者（16%）经历了BM累及其他部位（4名患者经历了BM+中枢神经系统，1名患者经历了BM+睾丸）。该组患者的 3 年生存率为 62.3%，而在首次挽救治疗后出现 CR 的患者中，3 年生存率为 79.5%（P 值为 36 个月，87.5%）。根据复发时的风险分层比较3年OS时，同样的趋势依然存在：低风险（LR），83.3%；中度风险（IR），80%；高风险（HR），44.8%：结论：报告的发病率和结果与国际报告的 CR1 持续时间数据相当。复发时的风险分层和挽救治疗后的缓解状态被认为是影响生存的重要预后因素。与接受化疗的患者相比，诱导后接受造血干细胞移植的患者生存率没有差异，这可能是由于样本量较小，因此需要进行多机构观察研究。这些发现证实了对新型疗法和治疗方法的需求。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.