Gogoi Manash Pratim, Das Parag, Das Nandana, Das Soumyadeep, Narula Gaurav, Trehan Amita, Bakhshi Sameer, Radhakrishnan Venkatraman, Seth Rachna, Tembhare Prashant, Singh Sachdeva Man Updesh, Chopra Anita, Sundersingh Shirley, Parihar Mayur, Bhattacharya Rahul, Banavali Shripad, Saha Vaskar, Krishnan Shekhar
Clinical Research Unit, Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, West Bengal, 700160, India.
Department of Statistics, Bidhannagar College, Kolkata, 700064, India.
Lancet Reg Health Southeast Asia. 2025 May 13;37:100593. doi: 10.1016/j.lansea.2025.100593. eCollection 2025 Jun.
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%.
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.
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).
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.
DBT-Wellcome; UKIERI, TCS Foundation.
高收入国家急性淋巴细胞白血病（ALL）患儿的总体生存率接近90%。在相同治疗方案下，印度患儿的生存率约为65%。
印度儿童白血病协作组（ICiCLe）利用遗传学和可测量残留病（MRD）将B细胞前体（BCP）ALL分为标准风险（SR）、中度风险（IR）和高风险（HR），以接受强度递增的治疗。T-ALL采用统一治疗。每年收集风险分层、死亡和复发数据。
2013年1月至2018年5月期间，共纳入2695例1-18岁患者。与其他患者相比，SR患者诱导期死亡显著降低（p = 0·002）。在中位时间61（59-62）个月时，SR患者4年无事件生存率和总生存率分别为76%（72-79%）和88%（85-90%）；IR患者为70%（66-74%）和80%（77-83%）；HR患者为61%（51-64%）和73%（70-76%）；T-ALL患者为69%（62-75%）和77%（70-83%）（p < 0·0001）。对于BCP-ALL，回归分析显示年龄、白细胞计数、巨大肿块、高风险遗传学和治疗中心是独立的预后变量。各中心治疗相关死亡（TRD）和复发的累积发生率分别为2%（1-5）至13%（10-17）（p ≤ 0·0001）；以及21%（17-26）至45%（39-51）（p ≤ 0·0001），MRD≥0·01%的BCP-ALL患者比例（p = 0·0007）和复发时间（p = 0·0001）存在显著差异。
风险分层指导下的强度降低治疗及协作可减少治疗相关死亡和复发。各中心遗传学和MRD检测的标准化以及获得高质量药物将进一步提高生存率。
DBT-Wellcome；UKIERI，塔塔咨询服务公司基金会
