Clinical features and prognosis of infant acute lymphoblastic leukemia
in China: A single-center retrospective analysis
Abstract
Background: In this retrospective analysis, we investigate the clinical
features and prognosis of 23 infant patients (< 1 year of age)
diagnosed with acute lymphoblastic leukemia (ALL). Methods: We used
clinical data of 23 children diagnosed with infant ALL at the Department
of Pediatric Hematology & Oncology, Wuhan Children’s Hospital, between
1st January 2014 and 30th September 2019. EFS and OS rate curves were
computed using the Kaplan-Meier estimator. The impact of prognostic
factors on outcome was analyzed using the Cox model. Results: The median
WBC was 46.14 (6.46–513) × 109/L at initial
diagnosis. All 21 patients immunophenotyped by flow cytometry had
B-lineage ALL. KMT2A-rearrangement was identified in 72.2%
(13/18)patients. Mutation screening for 13 patients indicated 4
patients with KRAS mutations, 4 with TTN mutations, 2 with NOTCH1
mutations, 2 with PTPN11 mutations and 2 with NRAS mutations. Of 12
patients who received chemotherapy, complete remission was achieved for
83.3% patients after one course of remission induction. A total of 3
patients underwent related haploidentical allogeneic hematopoietic stem
cell transplantation. The expected 2-year overall survival (OS) rate was
55.6 ± 15.2% and the expected event free survival rate (EFS) was 44.4 ±
15.7%. Univariate analysis revealed WBC > 100 ×
109/L at initial diagnosis as a risk factor for poor
OS and EFS. Conclusion: Treatment of infant ALL with the standard
childhood ALL regimen achieved an OS rate similar to patients with
high-risk ALL, and WBC at initial diagnosis may be an important
prognostic indicator.