Lineage classification of childhood acute lymphoblastic leukemia according to the EGIL recommendations: results of the ALL-BFM 2000 trial.

Abstract

BACKGROUND:

Flow cytometry immunophenotyping (FCM) is an undispensable tool for the diagnosis and for the treatment stratification of childhood acute lymphoblastic leukemia. The correlation of the EGIL-classification with prognostically relevant parameters like age, prednisone response and risk group is analyzed.

PATIENTS:

Between March 2000 and June 2009 12 patients less than 1 year of age, 1 836 patients with 1 to less than 6 years, 620 patients with 6 to less than 10 years, 615 patients with 10 to less than 15 years and 275 patients with 15 to less than 19 years were analyzed with a comprehensive 4-color antibody panel and classified according to the EGIL recommendations.

METHODS:

Bone marrow or peripheral blood mononuclear cells were isolated by ficoll gradient centrifugation, washed and stained with fluorochrome-conjugated antigen-specific monoclonal antibodies. Cell preparations were acquired and analyzed on a flow cytometer.

RESULTS:

Centralized FCM was performed for 2 775 patients (82.6%) with B-cell precursor acute lymphoblastic leukemia, 493 patients (14.7%) with T-cell acute lymphoblastic leukemia and 90 patients (2,7%) with biphenotypic acute leukemia. There was a slight overall predominance of male (56.1%) over female (43.9%) patients. Patients with B-cell precursor ALL had a slightly more favourable outcome with a 10 y pEFS of 78 ± 1.0%, compared to patients with a T-ALL or BAL (biphenotypic acute leukemia) phenotype with a 10 y pEFS of 74 ± 1.8% (n.s.) or 69 ± 9.0% (p<0.009), respectively.

CONCLUSIONS:

FCM according to the EGIL recommendations not only provides diagnostic lineage determination and subclassification but also enables an initial prognostic orientation before MRD (minimal residual disease)-based risk stratification becomes available.

• Authors: R Ratei, R Schabath, L Karawajew, M Zimmermann, A Möricke, M Schrappe, W-D Ludwig
• Journal: Klinische Padiatrie (Klin Padiatr) Vol. 225 Suppl 1 Pg. S34-9 (May 2013) ISSN: 1439-3824 [Electronic] Germany
• PMID: 23700065 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Cytarabine
• Vincristine
• Cyclophosphamide
• Mercaptopurine
• Asparaginase
• Prednisone
• Methotrexate
• Daunorubicin

Topics

• Adolescent
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Asparaginase (adverse effects, therapeutic use)
• Cell Lineage (genetics)
• Child
• Child, Preschool
• Cyclophosphamide (adverse effects, therapeutic use)
• Cytarabine (adverse effects, therapeutic use)
• Daunorubicin (adverse effects, therapeutic use)
• Female
• Flow Cytometry
• Humans
• Immunophenotyping
• Infant
• Leukemia, Biphenotypic, Acute (classification, drug therapy, genetics, mortality)
• Male
• Mercaptopurine (adverse effects, therapeutic use)
• Methotrexate (adverse effects, therapeutic use)
• Neoplasm, Residual (classification, drug therapy, genetics)
• Precursor B-Cell Lymphoblastic Leukemia-Lymphoma (classification, drug therapy, genetics, mortality)
• Precursor T-Cell Lymphoblastic Leukemia-Lymphoma (classification, drug therapy, genetics, mortality)
• Prednisone (adverse effects, therapeutic use)
• Prognosis
• Survival Analysis
• Vincristine (adverse effects, therapeutic use)