Steroid response as prognostic factor and its correlation with molecular assessment of childhood acute lymphoblastic leukemia
Abstract: Survival rate of
children with acute lymphoblastic leukemia
(ALL) in Indonesia remains low. Risk stratification accuracy is
important to improve survival. In developed countries, risk stratification is
determined based on gene fusion that is known related to steroid resistency.
Steroid response at day-8 correlates with prognosis. The assessment can be
applied in centers that cannot perform molecular assessment. This study aims to
evaluate whether steroid response correlated to molecular assessment.
Methods: A cross-sectional study was performed at Child Health
Department, Cipto Mangunkusumo Hospital (January 2013-March 2014), a total of
73 patients were enrolled. Steroid was given for 7 days. Peripheral blast count
at day 8 was evaluated, good response if blast count <1000 /µL and poor
if ≥1000 /µL. Fusion gene detection was
also performed. The data was analysed using Statistical Package for Social
Sciences (SPSS) version 20.0.
Results: Fusion gene was detected in 45 patients. In 1–10 years age
group, 26/32 (81%) subjects had good response, while 75% in <1 year age
group and 7/9 (78%) in ≥10 years age group had poor response. 5/7 (71%)
subjetcs had leukocyte count >100,000 /µL and 7/8 (88%) with T-cell showed
poor response. Age, leukocyte count, and T-cell were statistically correlated
with steroid response (p<0.05). E2A-PBX1 fusion gene was the most common
19/45 (42%), followed by TEL-AML1 17/45 (38%), BCR-ABL 5/45 (17%), and MLL-AF4
1/45 (3%). Four of five subjects (80%) with BCR-ABL and one subject with
MLL-AF4 had poor steroid response. On the other hand, 12/19 (63%) with E2A-PBX1
and 13/17 (77%) with TEL-AML1 had good response. There was no correlation
between steroid response and molecular assessment.
Conclusion: Steroid response correlates with age, leukocyte count, and
T-cell but not with molecular assessment.
Keywords: acute lymphoblastic
leukemia; molecular assessment; prognostic factor; steroid
Author: Murti Andriastuti, Djajadiman
Gatot, Riadi Wirawan, Rianto Setiabudy, Muchtaruddin Mansyur, I Dewa G.
Ugrasena
Journal Code: jpkedokterangg150327