title: Lineage classification of childhood acute lymphoblastic leukemia according to the EGIL recommendations: results of the ALL-BFM 2000 trial.
abstract: BACKGROUND
  Flow cytometry immunophenotyping (FCM) is an undispensable tool for the diagnosis and for the treatment stratification of childhood acute lymphoblastic leukemia. The correlation of the EGIL-classification with prognostically relevant parameters like age, prednisone response and risk group is analyzed.
  
  
  METHODS
  Between March 2000 and June 2009 12 patients less than 1 year of age, 1 836 patients with 1 to less than 6 years, 620 patients with 6 to less than 10 years, 615 patients with 10 to less than 15 years and 275 patients with 15 to less than 19 years were analyzed with a comprehensive 4-color antibody panel and classified according to the EGIL recommendations.
  
  
  METHODS
  Bone marrow or peripheral blood mononuclear cells were isolated by ficoll gradient centrifugation, washed and stained with fluorochrome-conjugated antigen-specific monoclonal antibodies. Cell preparations were acquired and analyzed on a flow cytometer.
  
  
  RESULTS
  Centralized FCM was performed for 2 775 patients (82.6%) with B-cell precursor acute lymphoblastic leukemia, 493 patients (14.7%) with T-cell acute lymphoblastic leukemia and 90 patients (2,7%) with biphenotypic acute leukemia. There was a slight overall predominance of male (56.1%) over female (43.9%) patients. Patients with B-cell precursor ALL had a slightly more favourable outcome with a 10 y pEFS of 78 ± 1.0%, compared to patients with a T-ALL or BAL (biphenotypic acute leukemia) phenotype with a 10 y pEFS of 74 ± 1.8% (n.s.) or 69 ± 9.0% (p<0.009), respectively.
  
  
  CONCLUSIONS
  FCM according to the EGIL recommendations not only provides diagnostic lineage determination and subclassification but also enables an initial prognostic orientation before MRD (minimal residual disease)-based risk stratification becomes available.
authors.affiliation: HELIOS Klinikum Berlin Buch, Clinic for Hematology, Oncology and Tumor Immunology, Berlin, Germany. richard.ratei@helios-kliniken.de
authors.forename: R
authors.initials: R
authors.lastname: Ratei
authors.forename: R
authors.initials: R
authors.lastname: Schabath
authors.forename: L
authors.initials: L
authors.lastname: Karawajew
authors.forename: M
authors.initials: M
authors.lastname: Zimmermann
authors.forename: A
authors.initials: A
authors.lastname: Möricke
authors.forename: M
authors.initials: M
authors.lastname: Schrappe
authors.forename: W-D
authors.initials: WD
authors.lastname: Ludwig
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001215:Asparaginase / Q000009:adverse effects / Q000627:therapeutic use; D019070:Cell Lineage / Q000235:genetics*; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D003561:Cytarabine / Q000009:adverse effects / Q000627:therapeutic use; D003630:Daunorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D016130:Immunophenotyping; D007223:Infant; D015456:Leukemia, Biphenotypic, Acute / Q000145:classification / Q000188:drug therapy* / Q000235:genetics* / Q000401:mortality; D008297:Male; D015122:Mercaptopurine / Q000009:adverse effects / Q000627:therapeutic use; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D018365:Neoplasm, Residual / Q000145:classification / Q000188:drug therapy / Q000235:genetics; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000145:classification / Q000188:drug therapy* / Q000235:genetics* / Q000401:mortality; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000145:classification / Q000188:drug therapy* / Q000235:genetics* / Q000401:mortality; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011379:Prognosis; D016019:Survival Analysis; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D003561:Cytarabine; D014750:Vincristine; D003520:Cyclophosphamide; D015122:Mercaptopurine; D001215:Asparaginase; D011241:Prednisone; D008727:Methotrexate; D003630:Daunorubicin