Risk stratified treatment for childhood acute lymphoblastic leukaemia: a multicentre observational study from IndiaResearch in context
Summary: Background: Overall survival rates of children with acute lymphoblastic leukaemia (ALL) in high-income countries approach 90%. Treated on the same protocols, outcomes in India, were ∼65%. Methods: The Indian Childhood Collaborative Leukaemia (ICiCLe) group used genetics and measurable resi...
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Elsevier
2025-06-01
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| Series: | The Lancet Regional Health - Southeast Asia |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772368225000642 |
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| author | Manash Pratim Gogoi Parag Das Nandana Das Soumyadeep Das Gaurav Narula Amita Trehan Sameer Bakhshi Venkatraman Radhakrishnan Rachna Seth Prashant Tembhare Man Updesh Singh Sachdeva Anita Chopra Shirley Sundersingh Mayur Parihar Rahul Bhattacharya Shripad Banavali Vaskar Saha Shekhar Krishnan |
| author_facet | Manash Pratim Gogoi Parag Das Nandana Das Soumyadeep Das Gaurav Narula Amita Trehan Sameer Bakhshi Venkatraman Radhakrishnan Rachna Seth Prashant Tembhare Man Updesh Singh Sachdeva Anita Chopra Shirley Sundersingh Mayur Parihar Rahul Bhattacharya Shripad Banavali Vaskar Saha Shekhar Krishnan |
| author_sort | Manash Pratim Gogoi |
| collection | DOAJ |
| description | Summary: Background: Overall survival rates of children with acute lymphoblastic leukaemia (ALL) in high-income countries approach 90%. Treated on the same protocols, outcomes in India, were ∼65%. Methods: The Indian Childhood Collaborative Leukaemia (ICiCLe) group used genetics and measurable residual disease (MRD) to categorise B-cell precursor (BCP) ALL as standard (SR), intermediate (IR) and high-risk (HR) to receive increasing intensity of therapy. T-ALL were treated uniformly. Data on risk stratification, deaths and relapses were collected annually. Findings: 2695 patients aged 1–18 years were enrolled between January 2013 and May 2018. Induction deaths were significantly lower in SR patients (p = 0·002) compared to others. At a median 61 (59–62) months, the 4-year event free and overall survival was 76% (72–79%) and 88% (85–90%) in SR; 70% (66–74%) and 80% (77–83%) in IR; 61% (51–64%) and 73% (70–76%) in HR; and 69% (62–75%) and 77% (70–83%) in T-ALL patients (p < 0·0001). For BCP-ALL, regression analyses showed age, white cell count, bulky disease, high risk genetics and treating centre as independent prognostic variables. The cumulative incidence of treatment deaths (TRD) and relapses at centres varied from 2% (1–5) to 13% (10–17) (p ≤ 0·0001); and 21% (17–26) to 45% (39–51) (p ≤ 0·0001) respectively with significant differences in proportion of BCP-ALL patients with MRD ≥ 0·01% (p = 0·0007) and time to relapse (p = 0·0001). Interpretation: Risk stratified directed reduced intensity treatment and collaboration decreases treatment deaths and relapses. Standardisation of genetic and MRD tests across centres and access to high quality drugs will lead to further improvements in survival. Funding: DBT-Wellcome; UKIERI, TCS Foundation. |
| format | Article |
| id | doaj-art-efe44e30b7e54ea0832f8bdbdff9e1c1 |
| institution | Kabale University |
| issn | 2772-3682 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | The Lancet Regional Health - Southeast Asia |
| spelling | doaj-art-efe44e30b7e54ea0832f8bdbdff9e1c12025-08-20T03:49:42ZengElsevierThe Lancet Regional Health - Southeast Asia2772-36822025-06-013710059310.1016/j.lansea.2025.100593Risk stratified treatment for childhood acute lymphoblastic leukaemia: a multicentre observational study from IndiaResearch in contextManash Pratim Gogoi0Parag Das1Nandana Das2Soumyadeep Das3Gaurav Narula4Amita Trehan5Sameer Bakhshi6Venkatraman Radhakrishnan7Rachna Seth8Prashant Tembhare9Man Updesh Singh Sachdeva10Anita Chopra11Shirley Sundersingh12Mayur Parihar13Rahul Bhattacharya14Shripad Banavali15Vaskar Saha16Shekhar Krishnan17Clinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, West Bengal, 700160, IndiaClinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, West Bengal, 700160, IndiaClinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, West Bengal, 700160, IndiaDepartment of Statistics, Bidhannagar College, Kolkata, 700064, IndiaDepartment of Pediatric Oncology, Tata Memorial Centre, Tata Memorial Hospital, Mumbai, Maharashtra, 400012, India; Homi Bhabha National Institute, Mumbai, Maharashtra, 40094, IndiaPediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, IndiaDepartment of Medical Oncology, BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, IndiaDepartment of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, 600020, IndiaDepartment of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, IndiaHematopathology Laboratory, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, 410210, IndiaDepartment of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, IndiaLaboratory Oncology, All India Institute of Medical Sciences, New Delhi, 110029, IndiaDepartment of Oncopathology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, 600020, IndiaCytogenetics Department, Tata Medical Center Kolkata, West Bengal, 700160, IndiaDepartment of Statistics, University of Calcutta, Kolkata, 700019, IndiaDepartment of Pediatric Oncology, Tata Memorial Centre, Tata Memorial Hospital, Mumbai, Maharashtra, 400012, India; Homi Bhabha National Institute, Mumbai, Maharashtra, 40094, IndiaClinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, West Bengal, 700160, India; Department of Paediatric Haematology and Oncology, Tata Medical Center, Kolkata, West Bengal, 700160, India; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M20 4GJ, UK; Corresponding author. Division of Cancer Sciences, Ogelsby Cancer Research Building, University of Manchester, Room 1.002, 1st Floor Ogelsby Cancer Research, M20 4GJ, UK.Clinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, West Bengal, 700160, India; Department of Paediatric Haematology and Oncology, Tata Medical Center, Kolkata, West Bengal, 700160, IndiaSummary: Background: Overall survival rates of children with acute lymphoblastic leukaemia (ALL) in high-income countries approach 90%. Treated on the same protocols, outcomes in India, were ∼65%. Methods: The Indian Childhood Collaborative Leukaemia (ICiCLe) group used genetics and measurable residual disease (MRD) to categorise B-cell precursor (BCP) ALL as standard (SR), intermediate (IR) and high-risk (HR) to receive increasing intensity of therapy. T-ALL were treated uniformly. Data on risk stratification, deaths and relapses were collected annually. Findings: 2695 patients aged 1–18 years were enrolled between January 2013 and May 2018. Induction deaths were significantly lower in SR patients (p = 0·002) compared to others. At a median 61 (59–62) months, the 4-year event free and overall survival was 76% (72–79%) and 88% (85–90%) in SR; 70% (66–74%) and 80% (77–83%) in IR; 61% (51–64%) and 73% (70–76%) in HR; and 69% (62–75%) and 77% (70–83%) in T-ALL patients (p < 0·0001). For BCP-ALL, regression analyses showed age, white cell count, bulky disease, high risk genetics and treating centre as independent prognostic variables. The cumulative incidence of treatment deaths (TRD) and relapses at centres varied from 2% (1–5) to 13% (10–17) (p ≤ 0·0001); and 21% (17–26) to 45% (39–51) (p ≤ 0·0001) respectively with significant differences in proportion of BCP-ALL patients with MRD ≥ 0·01% (p = 0·0007) and time to relapse (p = 0·0001). Interpretation: Risk stratified directed reduced intensity treatment and collaboration decreases treatment deaths and relapses. Standardisation of genetic and MRD tests across centres and access to high quality drugs will lead to further improvements in survival. Funding: DBT-Wellcome; UKIERI, TCS Foundation.http://www.sciencedirect.com/science/article/pii/S2772368225000642Acute lymphoblastic leukemiaPaediatricTreatmentLow middle income countries |
| spellingShingle | Manash Pratim Gogoi Parag Das Nandana Das Soumyadeep Das Gaurav Narula Amita Trehan Sameer Bakhshi Venkatraman Radhakrishnan Rachna Seth Prashant Tembhare Man Updesh Singh Sachdeva Anita Chopra Shirley Sundersingh Mayur Parihar Rahul Bhattacharya Shripad Banavali Vaskar Saha Shekhar Krishnan Risk stratified treatment for childhood acute lymphoblastic leukaemia: a multicentre observational study from IndiaResearch in context The Lancet Regional Health - Southeast Asia Acute lymphoblastic leukemia Paediatric Treatment Low middle income countries |
| title | Risk stratified treatment for childhood acute lymphoblastic leukaemia: a multicentre observational study from IndiaResearch in context |
| title_full | Risk stratified treatment for childhood acute lymphoblastic leukaemia: a multicentre observational study from IndiaResearch in context |
| title_fullStr | Risk stratified treatment for childhood acute lymphoblastic leukaemia: a multicentre observational study from IndiaResearch in context |
| title_full_unstemmed | Risk stratified treatment for childhood acute lymphoblastic leukaemia: a multicentre observational study from IndiaResearch in context |
| title_short | Risk stratified treatment for childhood acute lymphoblastic leukaemia: a multicentre observational study from IndiaResearch in context |
| title_sort | risk stratified treatment for childhood acute lymphoblastic leukaemia a multicentre observational study from indiaresearch in context |
| topic | Acute lymphoblastic leukemia Paediatric Treatment Low middle income countries |
| url | http://www.sciencedirect.com/science/article/pii/S2772368225000642 |
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