Uniform approach to risk classification and treatment assignment for children with acute lymphoblastic leukemia
Uniform approach to risk classification and treatment assignment for children with acute lymphoblastic leukemia
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DOI：
10.1200/jco.1996.14.1.18
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发表时间：
1996-01-01
影响因子：
45.3
通讯作者：
Ungerleider, R
中科院分区：
文献类型：
--
作者：
Smith, M;Arthur, D;Ungerleider, R
目的：为了确定更统一的标准，为儿童急性淋巴细胞白血病（ALL）的治疗分配的风险为基础的，癌症治疗评价计划（CTEP）的国家癌症研究所（NCI）主办了一个研讨会在1993年9月。参与者包括来自儿童癌症小组（CCG）、儿科肿瘤小组（FOG）、丹娜法伯癌症研究所（DFCI）、圣裘德儿童研究医院（SJCRH）和CTEP的代表。方法：研讨会参与者介绍并审查了所有临床试验的数据，使用加权平均值将来自不同组的结果数据联合收割机。结果：对于B前体（即非T、非B）ALL患者，标准风险类别（4年无事件生存率[EFS]，类似于80%）将包括1 - 9岁且诊断时WBC计数低于50，000/mu L的患者。其余患者将被归类为高风险ALL（4年EFS率，类似于65%）。对于T细胞ALL患者，不同的治疗策略对T细胞免疫表型的预后意义产生了不同的结论。因此，一些团体/机构将T细胞ALL患者归类为高风险，而其他团体/机构将根据统一的年龄/WBC计数标准为T细胞ALL患者分配风险。研讨会与会者一致认为，除年龄和白细胞计数标准外，患者的风险类别还可通过预后因素进行修改，并且应统一获得一组常见的预后因素，包括DNA指数（DI）、细胞遗传学、早期治疗反应、（例如，第14天的骨髓）、免疫表型和CNS状态。基于风险的治疗分配和收集特定预后因素的更统一的方法应提高未来ALL临床研究的效率。
Purpose: To define more uniform criteria for risk-based treatment assignment for children with acute lymphoblastic leukemia (ALL), the Cancer Therapy Evaluation Program (CTEP) of the National Cancer Institute (NCl) sponsored a workshop in September 1993. Participants included representatives from the Childrens Cancer Group (CCG), Pediatric Oncology Group (FOG), Dana-Farber Cancer Institute (DFCl), St Jude Children's Research Hospital (SJCRH), and the CTEP.Methods: Workshop participants presented and reviewed data from ALL clinical trials, using weighted averages to combine outcome data from different groups.Results: For patients with B-precursor (ie, non-T, non-B) ALL, the standard-risk category (4-year event-free survival [EFS] rate, similar to 80%) will include patients 1 to 9 years of age with a WBC count at diagnosis less than 50,000/mu L. The remaining patients will be classified as having high-risk ALL (4-year EFS rate, similar to 65%). For patients with T-cell ALL, different treatment strategies have yielded different conclusions concerning the prognostic significance of T-cell immunophenotype. Therefore, some groups/institutions will classify patients with T-cell ALL as high risk, while others will assign risk for patients with T-cell ALL based on the uniform age/WBC count criteria. Workshop participants agreed that the risk category of a patient may be modified by prognostic factors in addition to age and WBC count criteria, and that a common set of prognostic factors should be uniformly obtained, including DNA index (DI), cytogenetics, early response to treat ment (eg, day-14 bone marrow), immunophenotype, and CNS status.Conclusions: The more uniform approach to risk-based treatment assignment and to collection of specific prognostic factors should increase the efficiency of future ALL clinical research.