Can late relapse be predicted at initial diagnosis in childhood acute lymphoblastic leukemia?

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Abstract
We have investigated whether any prognostic factor can be used to identify those children who have a relapse after discontinuation of therapy for acute lymphoblastic leukemia (ALL). Our population-based series comprised 167 children with newly diagnosed ALL. The 3-year event-free survival rate in these children was 65%. Maintenance therapy was electively discontinued for 120 patients, 20 of whom have subsequently had a relapse 1 to 27 months later. In multivariate analysis the risk of late relapse in the 15 patients with initially enlarged kidneys was 4.5-fold (95% confidence limits 1.7-11.8) that of the others (p < 0.01). The risk in the 18 patients with initially elevated CSF protein concentration (> 0.4 g/l) or leukocyte count (> 5 .times. 106/l), but with no blasts in the CSF, was 3.8-fold (1.5-9.6) that of the others (p < 0.01). Our results indicate that enlarged kidneys or abnormal CSF findings at initial diagnosis are associated with an increased risk of late relapse in children with ALL.