[Factors associated with prognosis and treatment failure in children with acute lymphoblastic leukemia]

Abstract

Objectives: To explore the factors related to prognosis and treatment failure in children with acute lymphoblastic leukemia (ALL).

Methods: A retrospective study was conducted to collect and analyze clinical data of ALL children admitted to the Department of Pediatric Hematology at Tongji Hospital, Huazhong University of Science and Technology, from January 2012 to December 2019, with follow-up until June 2024.

Results: A total of 341 children with ALL were included. Among the 69 children with treatment failure, 55 (80%) experienced relapse, while 14 (20%) had non-relapse-related deaths, and no secondary tumors were observed. Initial WBC count ≥50×10⁹/L, positive minimal residual disease, and severe adverse events were identified as independent risk factors for treatment failure (P<0.05). Among the 55 relapsed patients, early relapses were predominant (36%), and the primary site of relapse was the bone marrow (56%). Immunophenotyping (P=0.009), initial WBC count (P=0.011), and fusion genes (P=0.040) were associated with the timing of relapse. High-risk status, T-cell ALL, relapse, and severe adverse events were independent risk factors affecting long-term survival (P<0.05).

Conclusions: The prognosis of children with ALL is related to risk stratification, immunophenotyping, relapse status, and occurrence of severe adverse events. Among these factors, relapse is the primary cause of treatment failure. Actively preventing relapse may reduce the treatment failure rate and improve long-term survival.

Keywords: Acute lymphoblastic leukemia; Child; Prognosis; Risk factor; Treatment failure.

图1. ALL儿童预后相关因素 ［T-ALL］急性T淋巴细胞白血病；［B-ALL］急性B淋巴细胞白血病；［OS］总生存。A：T-ALL患儿OS率明显低于B-ALL；B：高危组患儿OS率明显低于低中危组患儿；C：初诊时WBC≥50×10⁹/L患儿OS率明显低于WBC<50×10⁹/L患儿；D：诱导治疗后MRD阳性患儿OS率明显低于阴性患儿；E：发生SAE的患儿OS率明显低于无SAE患儿；F：复发患儿OS率明显低于无复发患儿；G：无复发后无移植患儿OS率明显低于移植患儿。