Increased post‐induction intensification improves outcome in children and adolescents with a markedly elevated white blood cell count (≥200 × 109/l) with T cell acute lymphoblastic leukaemia but not B cell disease: a report from the Children's Oncology Group |
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| Authors: | Caroline Hastings Paul S. Gaynon Harland N. Sather Xiaomin Lu Meenakshi Devidas Nita L. Seibel |
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| Affiliation: | 1. Department of Hematology Oncology, Children's Hospital & Research Center Oakland, Oakland, CA, USA;2. Division of Hematology Oncology, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA;3. Children's Oncology Group, Arcadia, CA, USA;4. Department of Biostatistics, Children's Oncology Group Statistics & Data Center, University of Florida, Gainesville, FL, USA;5. Clinical Investigations Branch, Cancer Therapy Evaluation Program, DCTD, National Cancer Institute, National Institutes of Health, Rockville, MD, USA |
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| Abstract: | Children and adolescents presenting with a markedly elevated white blood cell (ME WBC) count (WBC ≥200 × 109/l) comprise a unique subset of high‐risk patients with acute lymphoblastic leukaemia (ALL). We evaluated the outcomes of the 251 patients (12% of the study population) with ME WBC treated on the Children's Cancer Group‐1961 protocol. Patients were evaluated for early response to treatment by bone marrow morphology; those with a rapid early response were randomized to treatment regimens testing longer and stronger post‐induction therapy. We found that ME WBC patients have a poorer outcome compared to those patients presenting with a WBC <200 × 109/l (5‐year event‐free survival 62% vs. 73%, P = 0·0005). Longer duration of therapy worsened outcome for T cell ME WBC with a trend to poorer outcome in B‐ALL ME WBC patients. Augmented therapy benefits T cell ME WBC patients, similar to the entire study cohort, however, there appeared to be no impact on survival for B‐ALL ME WBC patients. ME WBC was not a prognostic factor for T cell patients. In patients with high risk features, B lineage disease in association with ME WBC has a negative impact on survival. |
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| Keywords: | acute lymphoblastic leukaemia paediatric intensification elevated white blood cell count |
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