All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit Know ALL.
The ALL Hub uses cookies on this website. They help us give you the best online experience. By continuing to use our website without changing your cookie settings, you agree to our use of cookies in accordance with our updated Cookie Policy
Introducing
Now you can personalise
your ALL Hub experience!
Bookmark content to read later
Select your specific areas of interest
View content recommended for you
Find out moreThe ALL Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the ALL Hub cannot guarantee the accuracy of translated content. The ALL Hub and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.
The ALL Hub is an independent medical education platform, sponsored by Jazz Pharmaceuticals, Amgen, and Pfizer. The funders are allowed no direct influence on our content. The levels of sponsorship listed are reflective of the amount of funding given. View funders.
Factors influencing survival following first relapse in ALL: A Children’s Oncology Group study
Bookmark this article
|
Survival outcomes remain poor for patients with ALL who experience relapse, with a 5-year OS rate of 36% post-relapse.1 While several factors such as age, WBC count, CNS involvement, cytogenetic subtype, and MRD inform risk stratification at diagnosis, similar indicators for post-relapse outcomes in ALL are limited. A retrospective cohort study of 16,115 pediatric, adolescent, and young adult patients with B-ALL, T-ALL, and infant ALL, of whom 12.7% had relapsed, from 12 COG first-line ALL trials, was performed to identify additional risk factors associated with OS post relapse. The results were published in Leukemia by Rheingold et al.1
|
| Key learnings |
|
Although relapse rates were similar overall between patients with B-ALL (12.5%) and T-ALL (11.2%), relapse was more common in the infant ALL cohort (34.2%). In patients with B-ALL, 48% of relapses occurred at ≥36 months, with 72.5% of these involving the bone marrow. Whereas, in patients with T-ALL, 64.8% of relapses occurred at <18 months, with 47.1% involving the CNS. |
|
In patients with B-ALL, MRD ≥0.01% at the end of induction during frontline therapy increased the risk of relapse post-relapse (p < 0.0001). |
|
Overall, the 5-year OS rate post relapse was 48.9%; 52.5% in B-ALL, 35.5% in T-ALL, and 21.5% in infant ALL (p < 0.001). Longer time-to-relapse was associated with improved 5-year OS rates (25.8%, 49.5%, and 66.4% for early, intermediate, and late time-to-relapse, respectively, in patients with B-ALL, and 29.8%, 33.3%, and 58%, respectively, in patients with T-ALL). |
|
Post-relapse OS was significantly associated with cytogenetic subtype (p < 0.001). Patients with ETV6::RUNX1 or trisomy 4+10 had better post-relapse OS rates of 74.4% and 70.2%, respectively; however, patients with hypodiploidy or KMT2A-r and TCF3::PBX1 had poor post-relapse OS rates of 14.2% and 31.9%, respectively. |
|
This large cohort study identified additional risk factors associated with OS post relapse in patients with ALL. The findings will not only help inform future trial designs but also highlight patient subgroups with worse outcomes post-relapse. |
Abbreviations: ALL, acute lymphoblastic leukemia; B-ALL, B-cell acute lymphoblastic leukemia; CNS, central nervous system; COG, Children’s Oncology Group; KMT2A-r, KMT2A rearrangement; MRD, measurable residual disease; OS, overall survival; T-ALL, T-cell acute lymphoblastic leukemia; WBC, white blood cell.
- Rheingold SR, Bhojwani D, Ji L, et al. Determinants of survival after first relapse of acute lymphoblastic leukemia: A Children's Oncology Group study. Leukemia. 2024. Online ahead of print. DOI: 10.1038/s41375-024-02395-4
More about...
Your opinion matters
6 votes - 50 days left ...
Related articles
Newsletter
Subscribe to get the best content related to ALL delivered to your inbox