Initial prognostic factors and lymphoblast-erythrocyte rosette formation in
109 children with acute lymphoblastic leukemia
LW Dow, L Borella, L Sen, RJ Aur, SL George, AM Mauer and JV Simone
Bone marrow lymphoblasts from 109 children admitted with untreated acute
lymphoblastic leukemia (ALL) were tested for spontaneous rosette formation
with sheep erythrocytes. Twenty-six children (24%) had lymphoblasts that
formed rosettes (E+). Of 13 initial clinical characteristics, 8 were
significantly associated with E+ lymphoblasts: mediastinal enlargement (86%
of patients E+), leukocyte counts over 100 X 10(9)/liter (65% E+), nodes
greater than 2 cm in any diameter (65% E+), age over 5 yr (46% E+),
hemoglobin over 8 g/dl (44% E+), hepatomegaly greater than 5 cm (38% E+),
boys (35% E+), and lymph node enlargement outside of the cervical area (28%
E+). Spleen size, initial platelet counts, and periodic acid-Schiff scores
did not distinguish E+ from E- patients. Since few patients were black and
few presented with central nervous system leukemia, the association of
these two characteristics with E+ blasts could not be determined. A
hierarchical classification scheme and a linear logistic regression model
were used to define the patterns of characteristics associated with E+
lymphoblasts. The initial clinical characteristics and the poorer course of
E+ patients suggest that ALL comprises at least two biologically and
clinically distinct types. The E+ ALL may result from a leukemic
transformation of a non-Hodgkin lymphoma.
Volume 50,
Issue 4,
pp. 671-682,
10/01/1977
Copyright © 1977 by The American Society of Hematology
