Assessment of the interrelationship of prognostic factors in childhood acute lymphoblastic leukemia: A report from Childrens Cancer Study Group

The pretreatment characteristics of 936 children with previously untreated acute lymphoblastic leukemia diagnosed from 1972 to 1975 were analyzed to determine their ability to predict subsequent prognosis. The patients’ treatment differed only in the type of CNS prophylaxis provided. Both univariate and multivariate analyses were performed to determine the relationship among patient characteristics and rate of remission induction, duration of initial bone marrow remission, and survival. The following patient characteristics were analyzed: initial white blood count (WBC), age at diagnosis, initial hemoglobin, initial platelet count, sex, race, pretreatment organomegaly, CNS leukemia at diagnosis, mediastinal mass, Down’s syndrome, and the type of CNS prophylaxis provided. Down’s syndrome and CNS leukemia at diagnosis were associated with a significantly lower remission induction rate. When analyzed in an univariate fashion, all factors studied, with the exception of Down’s syndrome and type of CNS prophylaxis, were significant predictors (p < 0.05) of the length of initial bone marrow remission and survival. Utilizing multivariate techniques, factors found to independently and significantly predict length of marrow remission duration were (listed in order of importance) initial WBC, sex, age at diagnosis, type of CNS prophylaxis, pretreatment nodal enlargement, initial hemoglobin, and initial platelet count.