期刊
BLOOD
卷 123, 期 1, 页码 70-77出版社
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2013-06-509463
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资金
- KiKa (Erasmus MC-Sophia Children's Hospital)
- Ergen Family Chair in Pediatric Cancer
- Women's Auxiliary Millennium Chair in Haematology/Oncology
- National Cancer Institute [CA 21765, 5 P01CA068484]
- American Lebanese Syrian Associated Charities (SJCRH)
- Israel Cancer Association
- Israel Science Foundation Legacy program
- Israel Science Foundation iCORE program
- Waxman Research Foundation
- Israel Cancer Research Foundation
- [CA98543]
- [U10CA98413]
- [U24 CA114766]
- MRC [G0300130] Funding Source: UKRI
- Medical Research Council [G0300130] Funding Source: researchfish
Children with Down syndrome (DS) have an increased risk of B-cell precursor (BCP) acute lymphoblastic leukemia (ALL). The prognostic factors and outcome of DS-ALL patients treated in contemporary protocols are uncertain. We studied 653 DS-ALL patients enrolled in 16 international trials from 1995 to 2004. Non-DS BCP-ALL patients from the Dutch Child Oncology Group and Berlin-Frankfurt-Munster were reference cohorts. DS-ALL patients had a higher 8-year cumulative incidence of relapse (26% +/- 2% vs 15% +/- 1%, P < .001) and 2-year treatment-related mortality (TRM) (7% +/- 1% vs 2.0% +/- < 1%, P < .0001) than non-DS patients, resulting in lower 8-year event-free survival (EFS) (64% +/- 2% vs 81% +/- 2%, P < .0001) and overall survival (74% +/- 2% vs 89% +/- 1%, P < .0001). Independent favorable prognostic factors include age <6 years (hazard ratio [HR] = 0.58, P = .002), white blood cell (WBC) count <10 x 10(9)/L (HR = 0.60, P = .005), and ETV6-RUNX1 (HR = 0.14, P = .006) for EFS and age (HR = 0.48, P < .001), ETV6-RUNX1 (HR = 0.1, P = .016) and high hyperdiploidy (HeH) (HR = 0.29, P = .04) for relapse-free survival. TRM was the major cause of death in ETV6-RUNX1 and HeH DS-ALLs. Thus, while relapse is the main contributor to poorer survival in DS-ALL, infection-associated TRM was increased in all protocol elements, unrelated to treatment phase or regimen. Future strategies to improve outcome in DS-ALL should include improved supportive care throughout therapy and reduction of therapy in newly identified good-prognosis subgroups.
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