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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Pediatric Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1405347
This article is part of the Research Topic Prognostic of New Strategies for Treating Children and Young Adults with Acute Lymphoblastic Leukemia View all 3 articles

Survival and prognostic factors for relapsed child hood acute lymphoblastic leukemia after treatment with the Chinese Children's Cancer Group ALL-201 5 protocol:A single center results

Provisionally accepted
Xia Chen Xia Chen 1Jie Yu Jie Yu 2*
  • 1 Children‘s Hospital of Chongqing Medical University, Chongqing, China
  • 2 Chongqing Key Laboratory of Child Infection and Immunity, Children 's Hospital, Chongqing Medical University, Chongqing, China

The final, formatted version of the article will be published soon.

    This retrospective study aims to analyze the survival and prognostic factors of relapsed childhood acute lymphoblastic leukemia treated with the Chinese Children's Cancer Group ALL-2015 protocol at the Children's Hospital of Chongqing Medical University. As of March 31, 2023, with a median follow-up of 53 months, 146 relapses were observed in 852 evaluable children. The cumulative incidence of relapse(CIR) at 8 years was (19.8±1.6)%, with 128 cases of B-ALL and 18 cases of T-ALL. No significant difference in CIR between B-ALL and T-ALL at 8 years was observed (P=0.271). Among the 105 cases re-treated after relapse, 70 achieved re-remission, resulting in a second complete remission (CR2) rate of 67.6%.The CR2 rates were lower for T-ALL relapse, relapse age ≥10 years old, and very early or early isolated bone marrow relapse. The 5-year EFS and OS for the 105 re-treated patients were (45.0 ± 5.4)% and (56.9 ± 5.2)%, respectively. Notably, the 5-year OS and EFS for B-ALL and T-ALL relapse were 51.3% vs 0.0% and 65.0% vs 0.0%, respectively, with a significant difference (P < 0.001). Further stratification based on relapse timing revealed that the 5-year EFS and OS were 28.4%, 44.4%, and 66.0% (P=0.001) and 47.2%, 55.3%, and 77.0% (P=0.003) for very early, early, and late relapses, respectively. Patients with isolated bone marrow relapse exhibited significantly lower 5-year EFS and OS compared to those with isolated extramedullary relapse (P<0.05). Significant factors affecting EFS after relapse included the site of relapse, immunophenotyping, CR2 achievement, and hematopoietic stem cell transplantation (HSCT). Immunophenotyping, CR2 achievement, and HSCT were also identified as significant factors affecting OS after relapse. Children treated with the CCCG-ALL-2015 protocol still had a notable relapse rate , and 72% (105/146) of children chose re-treatment after relapse. This study highlights the importance of considering specific prognostic factors for tailored treatment strategies in relapsed childhood ALL.

    Keywords: CHILDHOOD acute lymphoblastic leukemia, relapse, Chinese Childre n's Cancer Group ALL-2015 protocol, Survival, prognostic factors

    Received: 22 Mar 2024; Accepted: 10 Sep 2024.

    Copyright: © 2024 Chen and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Jie Yu, Chongqing Key Laboratory of Child Infection and Immunity, Children 's Hospital, Chongqing Medical University, Chongqing, China

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