Original scientific paper
https://doi.org/10.3325/cmj.2025.66.100
Disease characteristics and outcomes of Croatian pediatric patients with acute lymphoblastic leukemia: pretreatment immunophenotypic predictors of high bone marrow minimal residual disease on day 15 of treatment
Klara Dubravčić
; Division of Flow Cytometry, Department of Laboratory Diagnostics, Children’s Hospital Zagreb, Zagreb, Croatia
*
Ružica Lasan Trčić
; Division for Cytogenetics, Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croati
Ernest Bilić
; Department of Pediatric Hematology and Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
Josip Konja
; Department of Pediatric Hematology and Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
Ljubica Rajić
; Department of Pediatric Hematology and Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
Ranka Femenić
; Department of Pediatric Hematology and Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
Maja Pavlović
; Department of Pediatric Hematology and Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
Koraljka Gjadrov Kuveždić
; Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia
Sunčica Ries
; Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia
Mirna Sučić
; Division of Cytology, Department of Pathology and Cytology, Sveti Duh University Hospital, Zagreb, Croatia
Ivana Franić Šimić
; Division for Cytogenetics, Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
Renata Zadro
; Department of Laboratory Diagnostics, St Catherine Specialty Hospital, Zagreb, Croatia
Margareta Radić Antolic
; Division of Laboratory Hematology and Coagulation, Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
Ivana Horvat
; Medical- biochemical laboratory, Polyclinic Analiza, Varaždin, Croatia
Gordana Jakovljević
; Department of Oncology and Hematology, Children’s Hospital Zagreb, Zagreb, Croatia
Jelena Roganović
; Department of Oncology and Hematology, Children’s Hospital Zagreb, Zagreb, Croatia
Srđana Čulić
; Department of Pediatrics, University Hospital of Split, Split, Croatia
Dubravka Kuljiš
; Department of Pediatrics, University Hospital of Split, Split, Croatia
Višnja Armanda
; Department of Pediatrics, University Hospital of Split, Split, Croatia
Karolina Malić Tudor
; Department of Pediatrics, University Hospital of Split, Split, Croatia
Senada Šerifi
; Department of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Center Rijeka, Rijeka, Croatia
Bernarda Lozić
; Department of Pediatrics, University Hospital of Split, Split, Croatia
Drago Batinić
; Division of Laboratory Immunology, Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
* Corresponding author.
Abstract
Aim To assess the clinical-biological characteristics and outcomes of Croatian pediatric patients with acute lymphoblastic
leukemia (ALL). A secondary aim was to evaluate the predictive value of pretreatment leukemia-associated immunopheno
types (LAIPs) for poor early response to induction therapy defined as ≥10% day 15 bone marrow flow cytometry minimal
residual disease (FCM-MRD).
Methods This retrospective cohort study reviewed the medical data of 393 consecutive pediatric ALL patients diagnosed
and treated from February 2003 to April 2017 at four Croatian pediatric hemato-oncology centers. FCM data of 379 non-infant
patients enrolled in two consecutive intercontinental trials, ALL IC-BFM 2002 (NCT00764907) and ALL IC-BFM 2009 (EudraCT
2010-019722-13), were analyzed to evaluate the association between LAIPs at diagnosis and day 15 FCM-MRD≥10% using
univariate and multivariate logistic regression.
Results The median age at diagnosis was 5.2 years, with a predominance (83%) of B-cell precursor (BCP) ALL, and high hy
perdiploidy (25.1%) and ETV6::RUNX1 (18.7%) as the most common genetic abnormalities. The protocols did not significantly
differ in 5-year event-free survival (82.1% vs 81.7%), overall survival (88% vs 85%), and cumulative incidence of relapse (12.3%
vs 10%). FCM-MRD≥10% on day 15 was identified in 22.1% of patients and was predicted by white blood cell (WBC) count
≥20 × 109/L (P = 0.011) and strong expression of CD34 (P = 0.032) and CD13 (P = 0.001) at diagnosis.
Conclusion The characteristics and survival rates of Croatian pediatric ALL patients aligned with ALL IC-BFM data.
WBC≥20 × 109/L, CD34strong, and CD13strong independently predicted poor early response in BCP-ALL, suggesting a potential
prognostic value of LAIPs at diagnosis.
Keywords
Hrčak ID:
352477
URI
Publication date:
23.4.2025.
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