Outcome of children treated for relapsed acute lymphoblastic leukemia in Central America

Stacey Marjerrison, Federico Antillon, Ligia Fu, Roxana Martinez, Roberto Vasquez, Miguel Bonilla, Scott Howard, Lillian Sung

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Outcomes for relapsed childhood acute lymphoblastic leukemia (ALL) have not been documented in resource-limited settings. This study examined survival after relapse for children with ALL in Central America. METHODS: A retrospective cohort study was performed and included children with first relapse of ALL in Guatemala, Honduras, or El Salvador between 1990 and 2011. Predictors of subsequent event-free survival (EFS) and overall survival (OS) were examined. RESULTS: There were 755 children identified with relapsed disease. The median time from diagnosis to relapse was 1.7 years (interquartile range, 0.8-3.1 years). Most relapses occurred during (53.9%) or following (24.9%) maintenance chemotherapy, and the majority occurred in the bone marrow (63.1%). Following the initial relapse, subsequent 3-year EFS (± standard error) and OS were 22.0% ± 1.7%, and 28.2% ± 1.9%, respectively. In multivariable analysis, worse postrelapse survival was associated with age ≥ 10 years, white blood cell count ≥ 50 × 109/L, and positive central nervous system status at the original ALL diagnosis, relapse that was not isolated central nervous system or testicular, and relapse < 36 months following diagnosis. Site and time to relapse were used to identify a favorable risk group whose 3-year EFS and OS were 50.0% ± 8.9% and 68.0% ± 8.1%, respectively. CONCLUSIONS: Prognosis after relapsed ALL in Central America is poor, but a substantial number of those with favorable risk features have prolonged survival, despite lack of access to stem cell transplantation. Stratification by risk factors can guide therapeutic decision-making. Cancer 2013.

Original languageEnglish (US)
Pages (from-to)1277-1283
Number of pages7
JournalCancer
Volume119
Issue number6
DOIs
StatePublished - Mar 15 2013

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Central America
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Recurrence
Disease-Free Survival
Central Nervous System
El Salvador
Honduras
Maintenance Chemotherapy
Guatemala
Stem Cell Transplantation
Leukocyte Count
Decision Making
Cohort Studies
Retrospective Studies
Bone Marrow

All Science Journal Classification (ASJC) codes

  • Cancer Research
  • Oncology

Cite this

Marjerrison, S., Antillon, F., Fu, L., Martinez, R., Vasquez, R., Bonilla, M., ... Sung, L. (2013). Outcome of children treated for relapsed acute lymphoblastic leukemia in Central America. Cancer, 119(6), 1277-1283. https://doi.org/10.1002/cncr.27846

Outcome of children treated for relapsed acute lymphoblastic leukemia in Central America. / Marjerrison, Stacey; Antillon, Federico; Fu, Ligia; Martinez, Roxana; Vasquez, Roberto; Bonilla, Miguel; Howard, Scott; Sung, Lillian.

In: Cancer, Vol. 119, No. 6, 15.03.2013, p. 1277-1283.

Research output: Contribution to journalArticle

Marjerrison, S, Antillon, F, Fu, L, Martinez, R, Vasquez, R, Bonilla, M, Howard, S & Sung, L 2013, 'Outcome of children treated for relapsed acute lymphoblastic leukemia in Central America', Cancer, vol. 119, no. 6, pp. 1277-1283. https://doi.org/10.1002/cncr.27846
Marjerrison S, Antillon F, Fu L, Martinez R, Vasquez R, Bonilla M et al. Outcome of children treated for relapsed acute lymphoblastic leukemia in Central America. Cancer. 2013 Mar 15;119(6):1277-1283. https://doi.org/10.1002/cncr.27846
Marjerrison, Stacey ; Antillon, Federico ; Fu, Ligia ; Martinez, Roxana ; Vasquez, Roberto ; Bonilla, Miguel ; Howard, Scott ; Sung, Lillian. / Outcome of children treated for relapsed acute lymphoblastic leukemia in Central America. In: Cancer. 2013 ; Vol. 119, No. 6. pp. 1277-1283.
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AU - Howard, Scott

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N2 - Background: Outcomes for relapsed childhood acute lymphoblastic leukemia (ALL) have not been documented in resource-limited settings. This study examined survival after relapse for children with ALL in Central America. METHODS: A retrospective cohort study was performed and included children with first relapse of ALL in Guatemala, Honduras, or El Salvador between 1990 and 2011. Predictors of subsequent event-free survival (EFS) and overall survival (OS) were examined. RESULTS: There were 755 children identified with relapsed disease. The median time from diagnosis to relapse was 1.7 years (interquartile range, 0.8-3.1 years). Most relapses occurred during (53.9%) or following (24.9%) maintenance chemotherapy, and the majority occurred in the bone marrow (63.1%). Following the initial relapse, subsequent 3-year EFS (± standard error) and OS were 22.0% ± 1.7%, and 28.2% ± 1.9%, respectively. In multivariable analysis, worse postrelapse survival was associated with age ≥ 10 years, white blood cell count ≥ 50 × 109/L, and positive central nervous system status at the original ALL diagnosis, relapse that was not isolated central nervous system or testicular, and relapse < 36 months following diagnosis. Site and time to relapse were used to identify a favorable risk group whose 3-year EFS and OS were 50.0% ± 8.9% and 68.0% ± 8.1%, respectively. CONCLUSIONS: Prognosis after relapsed ALL in Central America is poor, but a substantial number of those with favorable risk features have prolonged survival, despite lack of access to stem cell transplantation. Stratification by risk factors can guide therapeutic decision-making. Cancer 2013.

AB - Background: Outcomes for relapsed childhood acute lymphoblastic leukemia (ALL) have not been documented in resource-limited settings. This study examined survival after relapse for children with ALL in Central America. METHODS: A retrospective cohort study was performed and included children with first relapse of ALL in Guatemala, Honduras, or El Salvador between 1990 and 2011. Predictors of subsequent event-free survival (EFS) and overall survival (OS) were examined. RESULTS: There were 755 children identified with relapsed disease. The median time from diagnosis to relapse was 1.7 years (interquartile range, 0.8-3.1 years). Most relapses occurred during (53.9%) or following (24.9%) maintenance chemotherapy, and the majority occurred in the bone marrow (63.1%). Following the initial relapse, subsequent 3-year EFS (± standard error) and OS were 22.0% ± 1.7%, and 28.2% ± 1.9%, respectively. In multivariable analysis, worse postrelapse survival was associated with age ≥ 10 years, white blood cell count ≥ 50 × 109/L, and positive central nervous system status at the original ALL diagnosis, relapse that was not isolated central nervous system or testicular, and relapse < 36 months following diagnosis. Site and time to relapse were used to identify a favorable risk group whose 3-year EFS and OS were 50.0% ± 8.9% and 68.0% ± 8.1%, respectively. CONCLUSIONS: Prognosis after relapsed ALL in Central America is poor, but a substantial number of those with favorable risk features have prolonged survival, despite lack of access to stem cell transplantation. Stratification by risk factors can guide therapeutic decision-making. Cancer 2013.

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