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Clinical and biologic features predict a poor prognosis in acute lymphoid
leukemias in infants: a Pediatric Oncology Group Study
W Crist, J Pullen, J Boyett, J Falletta, J van Eys, M Borowitz, J Jackson, B Dowell, L Frankel and F Quddus
Analysis of remission induction rates for 1,117 children 18 months to 10
years of age (group 1) and 90 infants less than 18 months of age (group 2)
with acute lymphoid leukemia (ALL) and of duration of continuous complete
remission (CCR) for 454 in group 1 and 33 in group 2 revealed that infants
fared significantly worse in both measures of outcome (P = .03 and P less
than .0001). To examine potential reasons for the poor prognosis of
affected infants, clinical and biologic features of their ALL were
compared. Infants had higher WBC counts (P less than .001), a higher
incidence of massive splenomegaly (P less than .001), massive hepatomegaly
(P less than .001), more central nervous system (CNS) disease at diagnosis
(P less than .01), and lower platelet counts (P less than .001). Also,
their blasts were less often PAS+ (P = .02). The incidence of non(T, B,
pre-B), T and pre-B immunophenotypes of ALL did not differ significantly
between the two groups. However, in patients with non(T, B, pre-B) ALL, the
majority (51%) of infants had common ALL antigen (CALLA)-negative blasts,
as compared with only 7% in group 1 (P less than .001). Furthermore,
infants with non(T, B, pre-B) cell ALL who were less than 12 months of age
were almost always CALLA- (18 of 21). The blasts of children from both
groups usually expressed Ia-like antigens. These data illustrate that
infants with ALL have extensive and bulky disease more often than do older
children and are more often affected with a prognostically unfavorable
phenotype of acute leukemia (AL) which expresses Ia-like antigens but is
more often PAS- and CALLA-. We believe that these clinical and biological
differences predict and explain in part the observed poor response to
treatment of infants with ALL.
Volume 67,
Issue 1,
pp. 135-140,
01/01/1986
Copyright © 1986 by The American Society of Hematology
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