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Patient characteristics
Source: Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 21, 2025 · Captured 2026-09-09.
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Context: Treatment of Relapsed Childhood ALL / Prognostic Factors After First Relapse of Childhood ALL
Age 10 years and older at initial diagnosis and at relapse have been reported as independent predictors of poor outcome.[13,17] A COG study demonstrated that patients aged 10 to 15 years at initial diagnosis had inferior outcomes compared with patients aged 1 to 9 years (5-year postrelapse survival rate, 36% vs. 58%), and those older than age 15 years did even worse (5-year OS rate, 29%).[15]
In a study from the Berlin-Frankfurt-Münster (BFM) group that included patients with B-ALL who were diagnosed at age 18 years or younger and experienced a late relapse, age at initial diagnosis was not a significant predictor of subsequent outcome when analyzed by quartiles. However, the outcome for patients aged 18 years and older at time of relapse was significantly inferior to the outcome for patients relapsing at age younger than 18 years (39.5% vs. 68.7%; P = .0001).[21]
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The BFM group has also reported that high peripheral blast counts (>10,000/μL) at the time of relapse were associated with inferior outcomes in patients with late marrow relapses.[10]
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Children with Down syndrome and ALL who relapse have generally had inferior outcomes resulting from increased induction deaths, treatment-related mortality, and relapse.
The BFM group showed that since 2000, improvements in supportive care have led to decreases in treatment-related mortality in children with Down syndrome, but the risk of relapse remains high.[22]
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An analysis of data from the Center for International Blood and Marrow Transplant Research (CIBMTR) on 27 patients with Down syndrome and ALL who underwent hematopoietic stem cell transplant (HSCT) between 2000 and 2009 substantiated this finding. They noted that with current transplant practices, hematopoietic recovery, graft-versus-host disease (GVHD), and transplant-related mortality were within the expected range compared with patients without Down syndrome. However, relapse was higher than expected (>50%) and was the primary cause of treatment failure, leading to poor survival (disease-free survival [DFS] rate at 3 years, 24%).[23][Level of evidence C1]
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Preserved source evidence · Not medical advice