AI Article Synopsis
- - The study examines the impact of IKZF1 deletion on prognosis in pediatric patients with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) and evaluates whether intensified chemotherapy can improve outcomes.
- - Results showed that patients with IKZF1 deletion had worse early treatment responses, lower disease-free survival (DFS), and overall survival (OS) rates compared to those without the deletion, although the cumulative incidence of relapse was similar between both groups.
- - Intensive chemotherapy was found to significantly improve DFS in the IKZF1 group, especially in patients with the BCR::ABL positive subtype, suggesting that intensified treatment could be beneficial for certain patients despite their initial poor prognosis.
Article Abstract
Background: IKZF1 deletion (IKZF1) is associated with poor prognosis in B-cell precursor acute lymphoblastic leukemia (BCP-ALL). But the prognosis of IKZF1 combined with other prognostic stratification factors remains unclear. Whether intensified treatment improves BCP-ALL prognosis has not been determined.
Methods: A retrospective analysis was performed on 1291 pediatric patients diagnosed with BCP-ALL and treated with the South China Children's Leukemia 2016 protocol. Patients were stratified based on IKZF1 status for comparison of characteristics and outcome. Additionally, IKZF1 patients were further divided based on chemotherapy intensity for outcome assessments.
Results: The BCP-ALL pediatric patients with IKZF1 in south China showed poorer early response. Notably, the DFS and OS for IKZF1 patients were markedly lower than IKZF1 group (3-year DFS: 88.7% [95% CI: 83.4%-94.0%] vs. 93.5% [95% CI: 92.0%-94.9%], P = .021; 3-year OS: 90.7% [95% CI: 85.8% to 95.6%] vs. 96.1% [95% CI: 95% to 97.2%, P = .003]), with a concurrent increase in 3-year TRM (6.4% [95% CI: 2.3%-10.5%] vs. 2.9% [95% CI: 1.9%-3.8%], P = .025). However, the 3-year CIR was comparable between the two groups (5.7% [95% CI: 1.8%-9.5%] vs. 3.7% [95% CI: 2.6%-4.7%], P = .138). Subgroup analyses reveal no factor significantly influenced the prognosis of the IKZF1 cohort. Noteworthy, intensive chemotherapy improved DFS from 85.7% ± 4.1% to 94.1% ± 0.7% in IKZF1 group (P = .084). Particularly in BCR::ABL positive subgroup, the 3-year DFS was remarkably improved from 53.6% ± 20.1% with non-intensive chemotherapy to 100% with intensive chemotherapy (P = .026).
Conclusions: Pediatric BCP-ALL patients with IKZF1 in South China manifest poor outcomes without independent prognostic significance. While no factor substantially alters the prognosis in the IKZF1 group. Intensified chemotherapy may reduce relapse rates and improve DFS in patients with IKZF1 subset, particularly in IKZF patients with BCR::ABL positive.
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| http://dx.doi.org/10.1111/ejh.14245 | DOI Listing |
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