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Prognostic Model of Den Boer et al for a Patient with Acute Lymphoblastic Leukemia Based on Chemotherapy Resistance Profiles

Description

Den Boer et al stratified children with acute lymphoblastic leukemia (ALL) based on the in vitro resistance to prednisolone, vincristine and asparaginase. This can identify patients who may benefit from more aggressive management. The authors are from the Dutch Childhood Leukemia Study Group and the German Cooperative Study Group for Childhood Acute Lymphoblastic Leukemia (COALL).


In vitro testing:

(1) prednisolone (P)

(2) vincristine (V)

(3) asparaginase (A)

 

Chemotherapeutic Agent

In Vitro Response

Points

prednisolone

sensitive

1

 

intermediate sensitivity

2

 

resistant

3

vincristine

sensitive

1

 

intermediate sensitivity

2

 

resistant

3

asparaginase

sensitive

1

 

intermediate sensitivity

2

 

resistant

3

 

PVA (prednisolone-vincristine-asparaginase) score =

= SUM(points for all 3 drugs)

 

Interpretation:

• minimum score: 3

• maximum score: 9

• A highly sensitive leukemia has a score of 3.

• A highly resistant leukemia has a score of 9.

 

The high risk group had higher rate of:

(1) nonresponse (no remission at 56 days after starting chemotherapy)

(2) relapse within 2.5 years of diagnosis

 

PVA Score

Risk Group

Rate of Nonresponse or Early Relapse

3 or 4

low

10%

5 or 6

intermediate

15%

7, 8 or 9

high

24%

 see Table 3, page 3265

 

The profile was not predictive of late relapse (relapse > 2.5 years after diagnosis).


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Specialty

ICD-10