Critical study of prognostic factors in childhood acute lymphoblastic leukaemia: differences in outcome are poorly explained by the most significant prognostic variables. Fralle group. French Acute Lymphoblastic Leukaemia study group.

Donadieu, J.;Auclerc, M F;Baruchel, A;Leblanc, T;Schaison, G.;et.al.
(1998) British Journal of Haematology — Vol. 102, n° 3, p. 729-739 (1998)

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  • Donadieu, J.
    Author
  • Auclerc, M F
    Author
  • Baruchel, A
    Author
  • Leblanc, T
    Author
  • Michel, Georges-HenryUCLouvain
    Author
  • Cornu, GuyUCLouvain
    Author
  • Schaison, G.
    Author
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Abstract
We determined the proportion of survival variability explained by the usual prognostic factors in childhood acute lymphoblastic leukaemia (ALL) during a prognostic study of 1552 patients enrolled in three consecutive Fralle group protocols (Fralle 83, Fralle 87 and Fralle 89). The event-free survival rates at 5 years were 54.8% (SD 1.9), 43.1%) (SD 2.7) and 55.6% (SD 2.2), respectively. In the univariate analysis the following variables were predictive of poor outcome: male gender, elevated leucocytosis (> 50 x 10(9)/l), circulating blastosis. haemoglobin >12 g/dl, platelet count <100 x 10(9)/l, age under 1 year or over 9 years, enlarged mediastinum, nodes, spleen and liver, T phenotype, absence of CD10+ cells; testicular and meningeal involvement, poor response to induction therapy (CCSG M3), and LDH >400 U/l. Among the cytogenetic features, hyperdiploidy had a protective effect, whereas hypodiploidy, translocation and other structural abnormalities had a negative influence, particularly in cases of t(9;22) or t(4;11). Multivariate analysis summarized the prognostic information in terms of four variables: age, gender, leucocytosis and cytogenetic features. Missing data had little influence on the results. However, despite their significance in the multivariate analysis, these four variables each had very low predictive power (1.1% for gender, 2.0% for age, 3.5% for leucocytosis, and 1.6% for cytogenetic features). Thus, the most significant prognostic factors in childhood ALL each explain no more than 4% of the variability in prognosis. This may explain the disappointing practical value of these factors and underlines the need for prognostic tools in childhood ALL.
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Donadieu, J., Auclerc, M. F., Baruchel, A., Leblanc, T., Landman-Parker, J., Perel, Y., Michel, G.-H., Cornu, G., Bordigoni, P., Sommelet, D., Leverger, G., Hill, C., & Schaison, G. (1998). Critical study of prognostic factors in childhood acute lymphoblastic leukaemia: differences in outcome are poorly explained by the most significant prognostic variables. Fralle group. French Acute Lymphoblastic Leukaemia study group. British Journal of Haematology, 102(3), 729-739. https://doi.org/10.1046/j.1365-2141.1998.00818.x (Original work published 1998)