Increased post-induction intensification improves outcome in children and adolescents with a markedly elevated white blood cell count (≥200 × 10(9) /l) with T cell acute lymphoblastic leukaemia but not B cell disease: a report from the Children's Oncology Group

Br J Haematol. 2015 Feb;168(4):533-46. doi: 10.1111/bjh.13160. Epub 2014 Oct 13.

Abstract

Children and adolescents presenting with a markedly elevated white blood cell (ME WBC) count (WBC ≥200 × 10(9) /l) comprise a unique subset of high-risk patients with acute lymphoblastic leukaemia (ALL). We evaluated the outcomes of the 251 patients (12% of the study population) with ME WBC treated on the Children's Cancer Group-1961 protocol. Patients were evaluated for early response to treatment by bone marrow morphology; those with a rapid early response were randomized to treatment regimens testing longer and stronger post-induction therapy. We found that ME WBC patients have a poorer outcome compared to those patients presenting with a WBC <200 × 10(9) /l (5-year event-free survival 62% vs. 73%, P = 0·0005). Longer duration of therapy worsened outcome for T cell ME WBC with a trend to poorer outcome in B-ALL ME WBC patients. Augmented therapy benefits T cell ME WBC patients, similar to the entire study cohort, however, there appeared to be no impact on survival for B-ALL ME WBC patients. ME WBC was not a prognostic factor for T cell patients. In patients with high risk features, B lineage disease in association with ME WBC has a negative impact on survival.

Keywords: acute lymphoblastic leukaemia; elevated white blood cell count; intensification; paediatric.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Asparaginase / administration & dosage
  • Child
  • Child, Preschool
  • Cranial Irradiation
  • Cyclophosphamide / administration & dosage
  • Daunorubicin / administration & dosage
  • Disease-Free Survival
  • Dose-Response Relationship, Drug
  • Doxorubicin / administration & dosage
  • Female
  • Follow-Up Studies
  • Humans
  • Idarubicin / administration & dosage
  • Infant
  • Kaplan-Meier Estimate
  • Leukemia, B-Cell / blood
  • Leukemia, B-Cell / drug therapy
  • Leukemia, B-Cell / mortality
  • Leukemia, B-Cell / radiotherapy
  • Leukocyte Count
  • Leukocytosis / etiology*
  • Male
  • Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / blood
  • Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / mortality
  • Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / radiotherapy
  • Prednisone / administration & dosage
  • Remission Induction
  • Risk
  • Treatment Outcome
  • Vincristine / administration & dosage

Substances

  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Asparaginase
  • Prednisone
  • Idarubicin
  • Daunorubicin

Supplementary concepts

  • PVDA protocol