title: Risk- and response-based classification of childhood B-precursor acute lymphoblastic leukemia: a combined analysis of prognostic markers from the Pediatric Oncology Group (POG) and Children's Cancer Group (CCG).
abstract: The Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG) joined to form the Children's Oncology Group (COG) in 2000. This merger allowed analysis of clinical, biologic, and early response data predictive of event-free survival (EFS) in acute lymphoblastic leukemia (ALL) to develop a new classification system and treatment algorithm. From 11 779 children (age, 1 to 21.99 years) with newly diagnosed B-precursor ALL consecutively enrolled by the CCG (December 1988 to August 1995, n=4986) and POG (January 1986 to November 1999, n=6793), we retrospectively analyzed 6238 patients (CCG, 1182; POG, 5056) with informative cytogenetic data. Four risk groups were defined as very high risk (VHR; 5-year EFS, 45% or below), lower risk (5-year EFS, at least 85%), and standard and high risk (those remaining in the respective National Cancer Institute [NCI] risk groups). VHR criteria included extreme hypodiploidy (fewer than 44 chromosomes), t(9;22) and/or BCR/ABL, and induction failure. Lower-risk patients were NCI standard risk with either t(12;21) (TEL/AML1) or simultaneous trisomies of chromosomes 4, 10, and 17. Even with treatment differences, there was high concordance between the CCG and POG analyses. The COG risk classification scheme is being used for division of B-precursor ALL into lower- (27%), standard- (32%), high- (37%), and very-high- (4%) risk groups based on age, white blood cell (WBC) count, cytogenetics, day-14 marrow response, and end induction minimal residual disease (MRD) by flow cytometry in COG trials.
authors.affiliation: Children's Oncology Group, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada. kschultz@interchange.ubc.ca
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Schultz
authors.forename: D Jeanette
authors.initials: DJ
authors.lastname: Pullen
authors.forename: Harland N
authors.initials: HN
authors.lastname: Sather
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Shuster
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Devidas
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Borowitz
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Carroll
authors.forename: Nyla A
authors.initials: NA
authors.lastname: Heerema
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Rubnitz
authors.forename: Mignon L
authors.initials: ML
authors.lastname: Loh
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Raetz
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Winick
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hunger
authors.forename: William L
authors.initials: WL
authors.lastname: Carroll
authors.forename: Paul S
authors.initials: PS
authors.lastname: Gaynon
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Camitta
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D002965:Classification; D020732:Cytogenetic Analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018365:Neoplasm, Residual; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000145:classification* / Q000175:diagnosis / Q000235:genetics / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000145:classification* / Q000175:diagnosis / Q000235:genetics / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers