Prognostic impact of absolute lymphocyte counts at the end of remission induction in childhood acute lymphoblastic leukemia

Authors

  • Jeffrey E. Rubnitz MD, PhD,

    Corresponding author
    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    • Corresponding author: Jeffrey E. Rubnitz, MD, PhD, Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN 38105-2794; Fax: (901) 521-9005; jeffrey.rubnitz@stjude.org

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  • Patrick Campbell MD, PhD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Yinmei Zhou MS,

    1. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • John T. Sandlund MD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Sima Jeha MD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Raul C. Ribeiro MD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Hiroto Inaba MD, PhD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Deepa Bhojwani MD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Mary V. Relling PharmD,

    1. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    2. Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Scott C. Howard MD,

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Dario Campana MD, PhD,

    1. Department of Pediatrics, National University of Singapore, Singapore
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  • Ching-Hon Pui MD

    1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    3. Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • We thank David Galloway, ELS, for expert editorial review; Tad McKeon for data collection; and Julie Groff for preparing the figures.

  • Ching-Hon Pui is an American Cancer Society Professor.

Abstract

BACKGROUND

Absolute lymphocyte counts (ALC) during treatment have been associated with outcome in children and adults with hematologic malignancies. However, the impact of ALC relative to that of other prognostic factors on the outcome of children with acute lymphoblastic leukemia (ALL) treated in recent trials is unknown.

METHODS

Outcomes of 399 patients aged ≤18 years with newly diagnosed ALL who were enrolled in the Total Therapy XV study at St. Jude Children's Research Hospital were analyzed according to ALC at the end of remission induction therapy.

RESULTS

An ALC ≥500 cells/μL was significantly more prevalent among patients with B-lineage ALL, in those with favorable presenting features, and in those who achieved negative minimal residual disease (MRD) status on day 43 of treatment. Both overall survival (OS) and event-free survival (EFS) were superior among patients with higher ALC, but only the association with OS was statistically significant in a univariate analysis. In multivariable analyses, ALC was not a significant predictor of outcome after controlling for age, leukocyte count, lineage, risk group, and MRD status at the end of induction (P > .1 for all comparisons). However, among MRD-negative patients, those with low ALC had a 5-year OS rate of 84.2% ± 8.9% versus 97.3% ± 1.0% for patients with higher ALC (P = .036).

CONCLUSIONS

ALC at the end of induction is related to favorable presenting features and good initial treatment response but does not independently predict outcome in the context of contemporary, MRD-guided therapy. Cancer 2013;119:2061–2066. © 2013 American Cancer Society.

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