title: Absolute lymphocyte count at the end of induction therapy is a prognostic factor in childhood acute lymphoblastic leukemia.
abstract: Recent studies have reported that the absolute lymphocyte count (ALC) during induction therapy is predictive of treatment outcome in de novo acute lymphoblastic leukemia (ALL); however, the significance of ALC on outcomes remains controversial. In the present study, we assessed the significance of ALC at day 29 (ALC-29), the end of induction therapy, on outcomes in our Japanese cohort. The outcomes of 141 patients aged ≤18 years with newly diagnosed ALL who were enrolled on the JACLS ALL-02 at our hospitals were analyzed in terms of ALC-29. Patients with ALC-29 ≥750/μL (n = 81) had a superior 5-year EFS (95.2 ± 2.7 vs 84.3 ± 4.8 %, P = 0.016) and OS (100 vs 87.0 ± 4.7 %, P = 0.0062). A multivariate analysis identified ALC-29 ≥750/μL as a significant predictor of improved EFS and OS after controlling for confounding factors. A multiple linear regression model revealed a significant inverse relationship between the percentage of blasts in bone marrow on day 15 and ALC-29 (P = 0.005). These results indicate that ALC is a simple prognostic factor in childhood ALL, and, thus, has the potential to refine current risk algorithms.
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirase
authors.affiliation: Department of Hematology and Oncology, Kobe Children's Hospital, 1-1-1, Takakuradai, Suma, Kobe, 654-0081, Japan. hasegawa_kch@hp.pref.hyogo.jp.
authors.forename: Daiichiro
authors.initials: D
authors.lastname: Hasegawa
authors.affiliation: Department of Pediatrics, Himeji Red Cross Hospital, 1-12-1 Shimoteno, Himeji Hyōgo, 670-8540, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Medical Statistics, Kobe Pharmaceutical University, 4-19-1 Motoyamakitamachi Higashinada, Kobe, 658-8558, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Moriwaki
authors.affiliation: Department of Hematology and Oncology, Kobe Children's Hospital, 1-1-1, Takakuradai, Suma, Kobe, 654-0081, Japan.
authors.forename: Atsuro
authors.initials: A
authors.lastname: Saito
authors.affiliation: Department of Hematology and Oncology, Kobe Children's Hospital, 1-1-1, Takakuradai, Suma, Kobe, 654-0081, Japan.
authors.forename: Aiko
authors.initials: A
authors.lastname: Kozaki
authors.affiliation: Department of Hematology and Oncology, Kobe Children's Hospital, 1-1-1, Takakuradai, Suma, Kobe, 654-0081, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ishida
authors.affiliation: Department of Hematology and Oncology, Kobe Children's Hospital, 1-1-1, Takakuradai, Suma, Kobe, 654-0081, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yanai
authors.affiliation: Department of Hematology and Oncology, Kobe Children's Hospital, 1-1-1, Takakuradai, Suma, Kobe, 654-0081, Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Kawasaki
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Kubokawa
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mori
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Hayakawa
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.|Department of Epidemiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Nishimura
authors.affiliation: Department of Epidemiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Hisahide
authors.initials: H
authors.lastname: Nishio
authors.affiliation: Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Iijima
authors.affiliation: Department of Hematology and Oncology, Kobe Children's Hospital, 1-1-1, Takakuradai, Suma, Kobe, 654-0081, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kosaka
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D018655:Lymphocyte Count; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality*; D011237:Predictive Value of Tests; D015996:Survival Rate
keywords: Absolute lymphocyte count; Acute lymphoblastic leukemia; Childhood