title: Prognostic factors for leukemic induction failure in children with acute lymphoblastic leukemia and outcome after salvage therapy: the FRALLE 93 study.
abstract: OBJECTIVE
  To identify prognostic factors and to evaluate the outcome of children with acute lymphoblastic leukemia (ALL) failure after induction therapy.
  
  
  METHODS
  Between June 1993 and December 1999, 1,395 leukemic children were included in the French Acute Lymphoblastic Leukemia 93 study.
  
  
  RESULTS
  Fifty-three patients (3.8%) had a leukemic induction failure (LIF) after three- or four-drug induction therapy. In univariate analysis, high WBC count (P = .001), mediastinal mass (P = .017), T-cell phenotype (T-ALL; P = .001), t(9;22) translocation (P = .001), and a slow early response (at day 8 and/or on day 21, P = .001) were predictive of LIF. The following three prognostic groups for LIF were identified by multivariate analysis: a low-risk group with B-cell progenitor (BCP) ALL without t(9;22) (odds ratio [OR] = 1), an intermediate-risk group with T-ALL and a mediastinal mass (OR = 7.4, P < .0001), and a high-risk group with BCP-ALL and t(9;22) or T-ALL without a mediastinal mass (OR = 28.4, P < .0001). Complete remission (CR) was subsequently obtained in 43 patients (81%). The 5-year overall survival (OS) rate of the 53 patients was 30% +/- 6%. The 5-year OS rate among allogeneic graft recipients, autologous graft recipients, and after chemotherapy were 30.4% +/- 9.6% (50% +/- 26% after genoidentical transplantation), 50% +/- 17.7%, and 41.7% +/- 14.2%, respectively (P = .18). Fourteen patients (26%) were still in first CR after a median of 83 months (range, 53 to 117 months).
  
  
  CONCLUSIONS
  Three risk categories for LIF in children with ALL were identified. Approximately one third of patients with LIF can be successfully treated with salvage therapy overall. Subsequent CR after LIF is mandatory for cure.
authors: Service d'Hématologie et Oncologie Pédiatrique, Hôpital Mère-Enfant, Limoges, France.
authors: Caroline
authors: C
authors: Oudot
authors: Marie-Françoise
authors: MF
authors: Auclerc
authors: Vincent
authors: V
authors: Levy
authors: Raphaël
authors: R
authors: Porcher
authors: Christophe
authors: C
authors: Piguet
authors: Yves
authors: Y
authors: Perel
authors: Virginie
authors: V
authors: Gandemer
authors: Marianne
authors: M
authors: Debre
authors: Christiane
authors: C
authors: Vermylen
authors: Brigitte
authors: B
authors: Pautard
authors: Claire
authors: C
authors: Berger
authors: Claudine
authors: C
authors: Schmitt
authors: Thierry
authors: T
authors: Leblanc
authors: Jean-Michel
authors: JM
authors: Cayuela
authors: Gérard
authors: G
authors: Socie
authors: Gérard
authors: G
authors: Michel
authors: Guy
authors: G
authors: Leverger
authors: André
authors: A
authors: Baruchel
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000188:drug therapy*; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D012307:Risk Factors; D016879:Salvage Therapy; D017211:Treatment Failure