No benefit of Interfant protocols compared to BFM‐based protocols for infants with acute lymphoblastic leukemia. Results from an institution in Argentina

• Published in: Pediatric blood & cancer 2020-10, Vol.67 (10), p.e28624-n/a
• Main Authors: Pennella, Carla L., Deu, María A., Rossi, Jorge G., Baialardo, Edgardo M., Alonso, Cristina N., Rubio, Patricia, Guitter, Myriam R., La Rosa, Cristian G. Sánchez, Alfaro, Elizabeth M., Zubizarreta, Pedro A., Felice, María S.
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Antineoplastic Combined Chemotherapy Protocols - classification; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Babies; chemotherapy; Comparative analysis; Female; Follow-Up Studies; Hematology; Humans; Infant; infant leukemia; Infants; Leukemia; Lymphatic leukemia; Male; Medical prognosis; Minimal residual disease; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - pathology; Oncology; outcomes research; Patients; pediatric hematology/oncology; Pediatrics; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology; Prognosis; Remission; Retrospective Studies; Risk groups; Survival Rate
• ISSN: 1545-5009; 1545-5017
• DOI: 10.1002/pbc.28624

Background Infant acute lymphoblastic leukemia (ALL) is an infrequent disease characterized by clinical and biological features related to poor prognosis. Adapted therapies were designed without a clear consensus regarding the best treatment options. We aimed to compare the outcome between infant ALL cases receiving Interfant versus BFM‐based protocols. Procedure This is a retrospective observational study. From April 1990 to June 2018, infant ALL cases were enrolled in one of the five consecutive treatment protocols. Clinical, demographic, and biological features and outcome were evaluated. A comparative analysis was performed between Interfant protocols and BFM‐based protocols. Results During the studied period, 1913 ALL patients were admitted and 116 (6%) were infants. Treatment administered was: ALL‐BFM’90 (n = 16), 1‐ALL96‐BFM/HPG (n = 7), Interfant‐99 (n = 39), Interfant‐06 (n = 35), and ALLIC‐BFM’2009 (n = 19). The 5‐year event‐free survival probability (EFSp) was 31.9(standard error [SE] 4.6)% for the entire population, with a significant difference among risk groups according to Interfant‐06 criteria (P = .0029). KMT2A‐rearrangement status was the strongest prognostic factor (P = .048), independently of the protocol strategy. The median time for relapse was 24.1 months for patients with minimal residual disease (MRD)‐negative versus 11.5 months for those with MRD‐positive (P = .0386). EFSp and cumulative relapse risk probability (CRRp) were similar. Interfant protocols showed comparable induction (8.1% vs 7.1%, P = .852) and complete remission mortality (21.6% vs 28.6%, P = .438), failing to reduce the relapse rate (48.5% vs 30.7%, P = .149). Conclusions Interfant protocols and BFM‐based protocols presented comparable results. The risk group stratification proposed by Interfant‐06 was validated by our results, and MRD seems useful to identify patients with an increased risk of early relapse.