title: Anemia and survival in childhood acute lymphoblastic leukemia.
abstract: BACKGROUND
  Several studies have demonstrated that patients with childhood acute lymphoblastic leukemia presenting with mild anemia at diagnosis have an increased risk of poor outcome compared to patients with more severe anemia. However, it has not been reported whether there is any correlation between degree of anemia and leukemia subtype.
  
  
  METHODS
  In a cohort of 1162 patients with childhood acute lymphoblastic leukemia we analyzed whether there was a correlation between degree of anemia and leukemia subtype. We also studied the association between degree of anemia and event-free survival within the subtypes.
  
  
  RESULTS
  Hemoglobin levels at diagnosis were distributed in a non-random pattern. The degree of anemia was significantly different for three distinct groups of patients compared to the remaining patients (mean hemoglobin; T-cell leukemia: 106 g/L versus 76 g/L (precursor B-cell acute lymphoblastic leukemia); within precursor B-cell ALL: TEL-AML1 positive: 68 g/L versus 79 g/L; BCR-ABL positive: 93 g/L versus 76 g/L; each p<0.05). Furthermore, in contrast to the entire study group, patients with T-cell leukemia, TEL-AML1(+), and BCR-ABL(+) precursor B-cell leukemia had a more favorable prognosis if presenting with a higher hemoglobin level (>/=80 g/L).
  
  
  CONCLUSIONS
  These observations indicate that the formerly reported direct correlation between severity of anemia and survival in childhood acute lymphoblastic leukemia mainly reflects differences in the degree of anemia between distinct biological subgroups with different treatment outcomes. On the other hand, the inverse relationship between severity of anemia and survival found within specific subgroups suggests that very low hemoglobin levels at diagnosis are associated with more advanced disease in these subgroups.
authors.affiliation: University Children's Hospital Zurich, Steinwiesstrasse 75 Zurich, 8032 Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Teuffel
authors.forename: Martin
authors.initials: M
authors.lastname: Stanulla
authors.forename: Gunnar
authors.initials: G
authors.lastname: Cario
authors.forename: Wolf D
authors.initials: WD
authors.lastname: Ludwig
authors.forename: Silja
authors.initials: S
authors.lastname: Rottgers
authors.forename: Beat W
authors.initials: BW
authors.lastname: Schafer
authors.forename: Martin
authors.initials: M
authors.lastname: Zimmermann
authors.forename: Martin
authors.initials: M
authors.lastname: Schrappe
authors.forename: Felix K
authors.initials: FK
authors.lastname: Niggli
mesh_terms: D000740:Anemia / Q000097:blood / Q000453:epidemiology*; D002051:Burkitt Lymphoma / Q000150:complications / Q000235:genetics / Q000401:mortality; D002648:Child; D015331:Cohort Studies; D050676:Core Binding Factor Alpha 2 Subunit / Q000235:genetics; D018572:Disease-Free Survival; D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D006454:Hemoglobins / Q000378:metabolism; D018398:Homeodomain Proteins / Q000235:genetics; D006801:Humans; D015458:Leukemia, T-Cell / Q000150:complications / Q000235:genetics / Q000401:mortality; D007958:Leukocyte Count; D009154:Mutation; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000235:genetics / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D050676:Core Binding Factor Alpha 2 Subunit; D006454:Hemoglobins; D018398:Homeodomain Proteins; D015514:Oncogene Proteins, Fusion; C493728:RUNX1 protein, human; C089847:E2A-Pbx1 fusion protein; D016044:Fusion Proteins, bcr-abl