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Persistence of circulating blasts after 1 week of multiagent chemotherapy
confers a poor prognosis in childhood acute lymphoblastic leukemia
A Gajjar, R Ribeiro, ML Hancock, GK Rivera, H Mahmoud, JT Sandlund, WM Crist and CH Pui
Department of Hematology-Oncology, St. Jude Children's Research Hospital,
Memphis 38101-0318, USA.
Early response to therapy, typically assessed by bone marrow status, is
predictive of outcome in childhood acute lymphoblastic leukemia (ALL). Less
is known about the significance of early clearance of blast cells in
peripheral blood. We reviewed medical records of all patients with ALL
enrolled on St Jude Total Therapy Study XI (February 1984 to September
1988) to determine the presence of blast cells in peripheral blood at
diagnosis and after 1 week of intensive induction therapy. Of the 358
patients, 59 lacked evidence of circulating blast cells at diagnosis, and
data were unavailable for 2 patients. The prognostic significance of
persistent circulating blast cells in the remaining 297 patients was
assessed in a multivariate analysis that included known adverse prognostic
factors. Persistent circulating leukemic blasts were present at day 8 in 41
patients (14%). Compared with the "blast- negative" group, these patients
had a significantly higher frequency of several adverse clinical features
(leukocyte count > 50 x 10(9)/L, mediastinal mass, central nervous
system leukemia, T-cell phenotype, lack of CD10 expression, and L2
morphology) and a significantly poorer 5-year event-free survival (34% +/-
8% [SE] v 77% +/- 3%, P < .01). By multivariate analysis, blast cell
persistence at week 1 was the most significant adverse feature in the
overall cohort (relative risk, 2.9; 95% confidence interval, 1.8 to 4.8)
and in an analysis limited to B- lineage cases (relative risk, 3.6; 95%
confidence interval, 1.9 to 7.1). Patients identified by this simple,
noninvasive measure may benefit from early modification of therapy.
Volume 86,
Issue 4,
pp. 1292-1295,
08/15/1995
Copyright © 1995 by The American Society of Hematology
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