PMID- 33684941
OWN - NLM
STAT- MEDLINE
DCOM- 20211203
LR  - 20240207
IS  - 1528-0020 (Electronic)
IS  - 0006-4971 (Print)
IS  - 0006-4971 (Linking)
VI  - 138
IP  - 4
DP  - 2021 Jul 29
TI  - Prognostic factors for CNS control in children with acute lymphoblastic leukemia 
      treated without cranial irradiation.
PG  - 331-343
LID - 10.1182/blood.2020010438 [doi]
AB  - To identify the prognostic factors that are useful to improve central nervous 
      system (CNS) control in children with acute lymphoblastic leukemia (ALL), we 
      analyzed the outcome of 7640 consecutive patients treated on Chinese Children's 
      Cancer Group ALL-2015 protocol between 2015 and 2019. This protocol featured 
      prephase dexamethasone treatment before conventional remission induction and 
      subsequent risk-directed therapy, including 16 to 22 triple intrathecal 
      treatments, without prophylactic cranial irradiation. The 5-year event-free 
      survival was 80.3% (95% confidence interval [CI], 78.9-81.7), and overall 
      survival 91.1% (95% CI, 90.1-92.1). The cumulative risk of isolated CNS relapse 
      was 1.9% (95% CI, 1.5-2.3), and any CNS relapse 2.7% (95% CI, 2.2-3.2). The 
      isolated CNS relapse rate was significantly lower in patients with B-cell ALL 
      (B-ALL) than in those with T-cell ALL (T-ALL) (1.6%; 95% CI, 1.2-2.0 vs 4.6%; 95% 
      CI, 2.9-6.3; P < .001). Independent risk factors for isolated CNS relapse 
      included male sex (hazard ratio [HR], 1.8; 95% CI, 1.1-3.0; P = .03), the 
      presence of BCR-ABL1 fusion (HR, 3.8; 95% CI, 2.0-7.3; P < .001) in B-ALL, and 
      presenting leukocyte count >/=50x109/L (HR, 4.3; 95% CI, 1.5-12.2; P = .007) in 
      T-ALL. Significantly lower isolated CNS relapse was associated with the use of 
      total intravenous anesthesia during intrathecal therapy (HR, 0.2; 95% CI, 
      0.04-0.7; P = .02) and flow cytometry examination of diagnostic cerebrospinal 
      fluid (CSF) (HR, 0.2; 95% CI, 0.06-0.6; P = .006) among patients with B-ALL. 
      Prephase dexamethasone treatment, delayed intrathecal therapy, use of total 
      intravenous anesthesia during intrathecal therapy, and flow cytometry examination 
      of diagnostic CSF may improve CNS control in childhood ALL. This trial was 
      registered with the Chinese Clinical Trial Registry (ChiCTR-IPR-14005706).
CI  - (c) 2021 by The American Society of Hematology.
FAU - Tang, Jingyan
AU  - Tang J
AUID- ORCID: 0000-0002-1905-5189
AD  - Department of Hematology/Oncology, Shanghai Children's Medical Center, School of 
      Medicine, Shanghai Jiao Tong University, National Health Committee Key Laboratory 
      of Pediatric Hematology & Oncology, Shanghai, China.
FAU - Yu, Jie
AU  - Yu J
AD  - Department of Hematology/Oncology, Chongqing Medical University Affiliated 
      Children's Hospital, Chongqing, China.
FAU - Cai, Jiaoyang
AU  - Cai J
AUID- ORCID: 0000-0003-2051-4044
AD  - Department of Hematology/Oncology, Shanghai Children's Medical Center, School of 
      Medicine, Shanghai Jiao Tong University, National Health Committee Key Laboratory 
      of Pediatric Hematology & Oncology, Shanghai, China.
FAU - Zhang, Li
AU  - Zhang L
AD  - Department of Pediatrics, State Key Laboratory of Experimental Hematology, 
      National Clinical Research Center for Blood Diseases, Institute of Hematology & 
      Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union 
      Medical College, Tianjin, China.
FAU - Hu, Shaoyan
AU  - Hu S
AD  - Department of Hematology/Oncology, Children's Hospital of Soochow University, 
      Suzhou, China.
FAU - Gao, Ju
AU  - Gao J
AD  - Department of Pediatrics, West China Second University Hospital, Sichuan 
      University, Key Laboratory of Birth Defects and Related Disease of Women and 
      Children, Ministry of Education, Chengdu, China.
FAU - Jiang, Hua
AU  - Jiang H
AD  - Department of Hematology/Oncology, Guangzhou Women and Children's Medical Center, 
      Guangzhou, China.
FAU - Fang, Yongjun
AU  - Fang Y
AD  - Department of Hematology/Oncology, Children's Hospital of Nanjing Medical 
      University, Nanjing, China.
FAU - Liang, Changda
AU  - Liang C
AD  - Department of Hematology/Oncology, Jiangxi Provincial Children's Hospital, 
      Nanchang, China.
FAU - Ju, Xiuli
AU  - Ju X
AD  - Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China.
FAU - Jin, Runming
AU  - Jin R
AUID- ORCID: 0000-0002-7233-0354
AD  - Department of Pediatrics, Union Hospital of Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, China.
FAU - Zhai, Xiaowen
AU  - Zhai X
AD  - Department of Hematology/Oncology, Children's Hospital of Fudan University, 
      Shanghai, China.
FAU - Wu, Xuedong
AU  - Wu X
AD  - Department of Pediatrics, Nanfang Hospital, Southern Medical University, 
      Guangzhou, China.
FAU - Tian, Xin
AU  - Tian X
AD  - Department of Hematology/Oncology, KunMing Children's Hospital, Kunming, China.
FAU - Hu, Qun
AU  - Hu Q
AD  - Department of Pediatrics, Tongji Hospital of Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, China.
FAU - Wang, Ningling
AU  - Wang N
AD  - Department of Pediatrics, Anhui Medical University Second Affiliated Hospital, 
      Anhui, China.
FAU - Jiang, Hui
AU  - Jiang H
AD  - Department of Hematology/Oncology, Children's Hospital Affiliated to Shanghai 
      Jiao Tong University, Shanghai, China.
FAU - Sun, Lirong
AU  - Sun L
AD  - Department of Pediatrics, Affiliated Hospital of Qingdao University, Qingdao, 
      China.
FAU - Leung, Alex W K
AU  - Leung AWK
AD  - Department of Pediatrics, Hong Kong Children's Hospital, The Chinese University 
      of Hong Kong, Hong Kong SAR, China.
FAU - Yang, Minghua
AU  - Yang M
AD  - Department of Pediatrics, Xiangya Hospital Central South University, Changsha, 
      China.
FAU - Pan, Kaili
AU  - Pan K
AD  - Department of Hematology/Oncology, Xi'an Northwest Women's and Children's 
      Hospital, Xi'an, China; and.
FAU - Cheng, Cheng
AU  - Cheng C
AD  - Departments of Oncology, Global Pediatric Medicine, Biostatistics and 
      Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN.
FAU - Zhu, Yiping
AU  - Zhu Y
AD  - Department of Pediatrics, West China Second University Hospital, Sichuan 
      University, Key Laboratory of Birth Defects and Related Disease of Women and 
      Children, Ministry of Education, Chengdu, China.
FAU - Zhang, Hui
AU  - Zhang H
AD  - Department of Hematology/Oncology, Guangzhou Women and Children's Medical Center, 
      Guangzhou, China.
FAU - Li, Chunfu
AU  - Li C
AD  - Department of Pediatrics, Nanfang Hospital, Southern Medical University, 
      Guangzhou, China.
FAU - Yang, Jun J
AU  - Yang JJ
AD  - Departments of Oncology, Global Pediatric Medicine, Biostatistics and 
      Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN.
FAU - Li, Chi-Kong
AU  - Li CK
AUID- ORCID: 0000-0002-2810-5758
AD  - Department of Pediatrics, Hong Kong Children's Hospital, The Chinese University 
      of Hong Kong, Hong Kong SAR, China.
FAU - Zhu, Xiaofan
AU  - Zhu X
AD  - Department of Pediatrics, State Key Laboratory of Experimental Hematology, 
      National Clinical Research Center for Blood Diseases, Institute of Hematology & 
      Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union 
      Medical College, Tianjin, China.
FAU - Shen, Shuhong
AU  - Shen S
AUID- ORCID: 0000-0002-0001-642X
AD  - Department of Hematology/Oncology, Shanghai Children's Medical Center, School of 
      Medicine, Shanghai Jiao Tong University, National Health Committee Key Laboratory 
      of Pediatric Hematology & Oncology, Shanghai, China.
FAU - Pui, Ching-Hon
AU  - Pui CH
AUID- ORCID: 0000-0003-0303-5658
AD  - Departments of Oncology, Global Pediatric Medicine, Biostatistics and 
      Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN.
LA  - eng
GR  - P30 CA021765/CA/NCI NIH HHS/United States
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Blood
JT  - Blood
JID - 7603509
SB  - IM
CIN - Blood. 2021 Jul 29;138(4):288-289. PMID: 34323942
MH  - Adolescent
MH  - Age Factors
MH  - *Central Nervous System Neoplasms/cerebrospinal fluid/mortality/therapy
MH  - Child
MH  - Child, Preschool
MH  - Disease-Free Survival
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - *Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/cerebrospinal 
      fluid/mortality/therapy
MH  - *Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/cerebrospinal 
      fluid/mortality/therapy
MH  - Risk Factors
MH  - Sex Factors
MH  - Survival Rate
PMC - PMC8323972
EDAT- 2021/03/09 06:00
MHDA- 2021/12/15 06:00
PMCR- 2022/07/29
CRDT- 2021/03/08 20:19
PHST- 2020/12/16 00:00 [received]
PHST- 2021/02/17 00:00 [accepted]
PHST- 2021/03/09 06:00 [pubmed]
PHST- 2021/12/15 06:00 [medline]
PHST- 2021/03/08 20:19 [entrez]
PHST- 2022/07/29 00:00 [pmc-release]
AID - S0006-4971(21)00634-0 [pii]
AID - 2021/BLD2020010438 [pii]
AID - 10.1182/blood.2020010438 [doi]
PST - ppublish
SO  - Blood. 2021 Jul 29;138(4):331-343. doi: 10.1182/blood.2020010438.