Purpose: In newly diagnosed childhood acute lymphoblastic leukemia (ALL), a high tumor burden indicates a poor prognosis, while no such link has been established yet after relapse. The impact of the absolute peripheral blast count (PBC) at the time of relapse on the response to salvage chemotherapy after a late isolated bone marrow (BM) relapse is the subject of this prospective analysis.
Patients And Methods: Since 1983, 260 children with a first isolated BM relapse of ALL that occurred 6 months or later after elective cessation of front-line therapy were enrolled onto four consecutive multicenter trials of the Berlin-Frankfurt-Münster (BFM) Relapse Study Group. All patients received intensive multiagent induction and consolidation chemotherapy for 6 months, followed by maintenance therapy with methotrexate (MTX) and thioguanine for 2 years. Treatment of subclinical meningeal leukemia consisted of high-dose intravenous MTX and intrathecally administered cytostatic drugs, which was augmented by cranial irradiation since 1988.
Results: At the time relapse was diagnosed, PBC varied considerably among patients (median, 1,060/microL; range, 0 to 106,800/microL). Achievement of a second complete remission (CR) was not significantly different in children without detectable circulating blasts at relapse (37 of 38) and those with moderate (1 to 9,999/microL) PBC (165 of 171). In contrast, only 42 of 51 children with high PBC (> or = 10,000/microL) achieved a second CR (P = .0015). At a median follow-up time of 40 months, the 10-year event-free survival (EFS) probability was significantly (P = .0001) higher in children without circulating blasts (.64) than in children with moderate PBC (.32) or high PBC (.10). There was a preponderance of boys in the group without detectable circulating blasts, while the three PBC-defined groups did not differ with respect to frontline treatment, age at initial diagnosis, age at relapse, time off therapy, or salvage treatment protocol. On sequential univariate and multivariate analysis, only duration of first remission > or = 48 months was an additional independent indicator of adverse prognosis, while preventive cranial irradiation improved outcome independently of PBC.
Conclusion: The absence of blasts on peripheral-blood smears at the time of a first late isolated BM relapse of childhood ALL is associated with a favorable response and prognosis in chemotherapy-treated children, who should be regarded as ineligible for bone marrow transplantation (BMT) unless a second round of chemotherapy has failed to produce a response.
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http://dx.doi.org/10.1200/JCO.1996.14.10.2812 | DOI Listing |
BMC Pediatr
January 2025
Department of Neonatology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
Background: Group B Streptococcus (GBS) is the most common cause of neonatal early onset sepsis in term infants and a major cause of late onset sepsis in both term and preterm infants.
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Narra J
December 2024
Department of Neurology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.
Premature and low birth weight neonates often struggle with oral intake due to immaturity or respiratory distress. Forkhead box protein 2 gene () is predicted to influence oral feeding ability in newborns, but studies assessing the role of this gene in influencing oral feeding ability are limited. The aim of this study was to investigate the role of gene polymorphism, particularly single nucleotide polymorphism (SNP) rs17137124, on the duration of orogastric tube (OGT) use in moderate to late preterm neonates.
View Article and Find Full Text PDFBMC Cancer
January 2025
Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany.
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View Article and Find Full Text PDFPoult Sci
January 2025
Key Laboratory of Conservation and Utilization of Biological Resources in the Tarim Basin, Alar, Xinjiang 843300, China; College of Life Science and Technology, Tarim University, Alar, Xinjiang 843300, China. Electronic address:
This study investigated the probiotic potential of lactic acid bacteria (LAB) strains isolated from the intestines of quails during the late egg-laying period. Eight LAB strains were examined for their tolerance to acid and bile salts, antibiotic susceptibility, self-aggregation, hydrophobicity, and antibacterial activity. Among these, E.
View Article and Find Full Text PDFMol Biol Cell
January 2025
Department of Molecular Genetics, The Ohio State University, Columbus, OH 43210.
The Munc13/UNC-13 family protein Ync13 is essential for septum integrity and cytokinesis in fission yeast. To further explore the mechanism of Ync13 functions, spontaneous suppressors of mutants, which can suppress the colony-formation defects and lysis phenotype of mutant cells, are isolated and characterized. One of the suppressor mutants, -, shows defects in the cytokinetic contractile ring constriction, septation, and daughter-cell separation, similar to mutant.
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