Prognostic significance of steroid response in pediatric acute lymphoblastic leukemia: The CCCG-ALL-2015 study

Effect of nutritional screening in children with acute lymphoblastic leukemia undergoing the maintenance chemotherapy

BACKGROUND

To investigate the effectiveness of the routine nutritional screening for malnutrition risk in hospitalized children with acute lymphoblastic leukemia (ALL) on maintenance chemotherapy from the viewpoint of clinical outcomes.

METHODS

The reviews of 1038 pediatric patients were retrieved for the retrospective, propensity score-matched, superiority study. A 1:1 propensity score matching was utilized to match patients who received nutritional screening (screening cohort) to those who remained usual care without screening (control cohort). The primary endpoint was the long-term event-free-survival (EFS) after the last cycle of maintenance. Secondary outcomes included immune function, complications and long-term quality-adjusted life years (QALYs).

RESULTS

The proportion of cases with risk of malnutrition in screening was 25.8%. At the end of 4 weeks following the last cycle, the level of serum albumin was higher in screening cohort than control cohort (p < 0.001), while the cellular immune function significantly improved in screening cohort (all p < 0.05). During a mean of 11.09 ± 6.45 months follow-up, 28.6% of patients in screening cohort had an event including ALL-related emergency visits, readmitted hospitalizations and severe infections compared to 46.5% of cases in control cohort yielding a hazard ratio of 0.397 (95%CI: 0.306, 0.493 and a significant difference in long-term EFS (24.07 (95%CI: 23.09, 25.04) vs. 18.02 (95%CI: 16.62, 19.42), log-rank p < 0.001). The means of QALYs calculated by area under the curve up to 3, 6, 12 and 24 months after discharge were significantly lower in screening cohort as opposed to control cohort (all p < 0.05).

CONCLUSIONS

Pediatric ALL receiving the specific-for-children nutritional screening during hospitalization exhibited a better EFS over the 24-month follow-up than cases without screening. The benefit accounted for a significant improvement in immune function and QALYs scores over long-term follow-up.

CLINICAL TRIAL NUMBER

Not applicable.

Survival and prognostic factors for relapsed childhood acute lymphoblastic leukemia after treatment with the Chinese children's cancer group ALL-2015 protocol: a single center results

Introduction

This retrospective study was conducted to assess the survival rates and prognostic factors in children with relapsed acute lymphoblastic leukemia (ALL) who were treated according to the Chinese Children's Cancer Group ALL-2015 protocol at the Children's Hospital of Chongqing Medical University.

Methods

The study cohort involving 852 evaluable children with ALL reported a total of 146 relapses during a median follow-up period of 53 months. The primary outcomes measured were the second complete remission (CR2) rates, and 5-year event-free survival (EFS) and overall survival (OS) for patients who received re-treatment post-relapse. Patient data were stratified by ALL subtype (B-ALL vs. T-ALL), age at relapse, site of relapse, and timing of relapse. Univariate and multivariate analyses were performed to identify factors significantly associated with EFS and OS.

Results

As of March 31, 2023, 146 relapses were observed, including 128 B-ALL and 18 T-ALL cases. The 8-year CIR was (19.8 ± 1.6)%, with no significant difference between B-ALL and T-ALL (P=0.271). Among the 105 patients who underwent re-treatment, 70 achieved CR2, resulting in a CR2 rate of 67.6%. The 5-year EFS and OS rates for re-treated patients were (45.0 ± 5.4)% and (56.9 ± 5.2)%, respectively. Significant differences in 5-year OS and EFS were found between B-ALL and T-ALL relapses (P < 0.001). The 5-year EFS and OS varied significantly with relapse timing and site of relapse. Factors significantly 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.

Discussion

Despite treatment with the CCCG-ALL-2015 protocol, a significant relapse rate was observed, with 72% of children opting for re-treatment post-relapse. The study highlights the importance of considering specific prognostic factors to inform tailored treatment strategies for relapsed childhood ALL. The findings emphasize the need for further research into improving therapeutic approaches for this patient population. This retrospective study was conducted to assess the survival rates and prognostic factors in children with relapsed acute lymphoblastic leukemia (ALL) who were treated according to the Chinese Children's Cancer Group ALL-2015 protocol at the Children's Hospital of Chongqing Medical University.

[Risk factors for recurrence of childhood acute lymphoblastic leukemia after treatment with the Chinese Children's Cancer Group ALL-2015 protocol]

OBJECTIVES

To investigate the cumulative incidence of recurrence (CIR) in children with acute lymphoblastic leukemia (ALL) after treatment with the Chinese Children's Cancer Group ALL-2015 (CCCG-ALL-2015) protocol and the risk factors for recurrence.

METHODS

A retrospective analysis was conducted on the clinical data of 852 children who were treated with the CCCG-ALL-2015 protocol from January 2015 to December 2019. CIR was calculated, and the risk factors for the recurrence of B-lineage acute lymphoblastic leukemia (B-ALL) were analyzed.

RESULTS

Among the 852 children with ALL, 146 (17.1%) experienced recurrence, with an 8-year CIR of 19.8%±1.6%. There was no significant difference in 8-year CIR between the B-ALL group and the acute T lymphocyte leukemia group (P>0.05). For the 146 children with recurrence, recurrence was mainly observed in the very early stage (n=62, 42.5%) and the early stage (n=46, 31.5%), and there were 42 children with bone marrow recurrence alone (28.8%) in the very early stage and 27 children with bone marrow recurrence alone (18.5%) in the early stage. The Cox proportional-hazards regression model analysis showed that positive MLLr fusion gene (HR=4.177, 95%CI: 2.086-8.364, P<0.001) and minimal residual disease≥0.01% on day 46 (HR=2.013, 95%CI: 1.163-3.483, P=0.012) were independent risk factors for recurrence in children with B-ALL after treatment with the CCCG-ALL-2015 protocol.

CONCLUSIONS

There is still a relatively high recurrence rate in children with ALL after treatment with the CCCG-ALL-2015 protocol, mainly bone marrow recurrence alone in the very early stage and the early stage, and minimal residual disease≥0.01% on day 46 and positive MLLr fusion gene are closely associated with the recurrence of B-ALL.