title: Low platelet counts after induction therapy for childhood acute lymphoblastic leukemia are strongly associated with poor early response to treatment as measured by minimal residual disease and are prognostic for treatment outcome.
abstract: BACKGROUND
  Numerous reports have been published on the association between kinetics of leukemic cells during early treatment of childhood acute lymphoblastic leukemia and therapeutic outcome. In contrast, little is known about the prognostic relevance of normal blood counts in this setting.
  
  
  METHODS
  Normal hematopoiesis during and after induction treatment (days 8, 15 and 33) was correlated with therapeutic outcome in a cohort of 256 children with acute lymphoblastic leukemia treated in one of three consecutive ALL-BFM trials at a single institute. Replication analysis of positive findings was performed in an independent cohort of 475 patients from the ALL-BFM 2000 multicenter trial.
  
  
  RESULTS
  A platelet count in the first quartile on treatment day 33 and a neutrophil count above the median on day 8 were significantly associated with treatment outcome, conferring multivariate risk ratios for an event of 3.27 (95% confidence interval 1.60-6.69) and 2.26 (95% confidence interval 1.23-4.29), respectively. Replication analysis confirmed the prognostic effect of platelet count on treatment day 33 and demonstrated a strong association with minimal residual disease-based risk group distribution (P<0.00001).
  
  
  CONCLUSIONS
  Platelet counts after induction treatment may improve treatment stratification for patients with childhood acute lymphoblastic leukemia and be of particular interest in non-minimal residual disease-based trials. (ALL-BFM 2000 is registered at: ClinicalTrials.gov: NCT00430118. National Cancer Institute: Protocol ID 68529).
authors: Department of Molecular Hematopoiesis, Hannover Medical School, Hannover, Germany.
authors: Lutz
authors: L
authors: Zeidler
authors: Martin
authors: M
authors: Zimmermann
authors: Anja
authors: A
authors: Möricke
authors: Barbara
authors: B
authors: Meissner
authors: Dorothee
authors: D
authors: Bartels
authors: Christoph
authors: C
authors: Tschan
authors: André
authors: A
authors: Schrauder
authors: Gunnar
authors: G
authors: Cario
authors: Lilia
authors: L
authors: Goudeva
authors: Sarah
authors: S
authors: Jäger
authors: Richard
authors: R
authors: Ratei
authors: Wolf-Dieter
authors: WD
authors: Ludwig
authors: Andrea
authors: A
authors: Teigler-Schlegel
authors: Julia
authors: J
authors: Skokowa
authors: Rolf
authors: R
authors: Koehler
authors: Claus R
authors: CR
authors: Bartram
authors: Hansjörg
authors: H
authors: Riehm
authors: Martin
authors: M
authors: Schrappe
authors: Karl
authors: K
authors: Welte
authors: Martin
authors: M
authors: Stanulla
mesh_terms: D000293:Adolescent; D001772:Blood Cell Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018365:Neoplasm, Residual; D010976:Platelet Count; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome