Mediastinal mass in childhood T-cell acute lymphoblastic leukemia: Significance and therapy response

✍ Scribed by Attarbaschi, Andishe ;Mann, Georg ;Dworzak, Michael ;Wiesbauer, Peter ;Schrappe, Martin ;Gadner, Helmut

• Publisher: John Wiley and Sons
• Year: 2002
• Tongue: English
• Weight: 156 KB
• Volume: 39
• Category: Article
• ISSN: 0098-1532
• DOI: 10.1002/mpo.10164

✦ Synopsis

Abstract

Background

T‐cell acute lymphoblastic leukemia (T‐ALL) accounts for ∼10–13% of childhood ALL cases. Patients with T‐ALL frequently present with unfavorable features at diagnosis and thus are considered to have a higher risk to relapse. Within the last 10 years, the previously dismal prognosis of this ALL subtype has been improved by intensified chemotherapy. However, 30–40% of patients still relapse, so that additional prognostic factors such as the local response of the mediastinal mass to therapy might allow defining the patients at risk in a better manner.

Procedure

A retrospective analysis of 116 Austrian patients with T‐ALL was performed to assess whether an initial mediastinal mass (70/116) and its response to chemotherapy as measured by thoracic X‐rays (32/70) might predict outcome.

Results

Neither patients with a mediastinal tumor at the time of diagnosis nor patients with an incomplete response on day 35 or 70 of therapy had a worse prognosis, as compared with the group of patients with no initial tumor and complete regression on day 35 and 70.

Conclusions

We failed to show that in children with T‐ALL residual mediastinal tumors are of prognostic relevance. This might suggest that incomplete local response is not necessarily an indication for treatment intensification such as local irradiation, second‐look operation, or high‐dose chemotherapy with bone marrow rescue. However, due to the relatively small number of patients analyzed, our results have to be validated prospectively on a larger cohort of patients in future clinical trials. Med Pediatr Oncol 2002;39:558–565. © 2002 Wiley‐Liss, Inc.