ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Hematology and Hematological Malignancies
This article is part of the Research TopicAdvances in the Diagnosis and Treatment of Pediatric Hematological DisordersView all 3 articles
Pediatric Acute Lymphoblastic Leukemia Relapse and Prognosis: Key Predictors and Therapeutic Implications
Provisionally accepted
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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Background: Pediatric acute lymphoblastic leukemia (ALL), the most common childhood malignancy, achieves >95% 5-year survival with risk-adapted therapies. Nonetheless, 10-15% of patients experience relapse, with post-relapse survival <50%. Challenges remain in optimizing minimal residual disease (MRD)-guided strategies and salvage therapies in ALL. Aims: This study aimed to identify relapse predictors and assess post-relapse outcomes among 436 pediatric ALL patients treated according to the CCCG-ALL-2015 protocol. Results: Of the 436 enrolled patients (median age: 3.9 years; 92.4% B-ALL), sixty-four patients (14.7%) relapsed, predominantly with isolated bone marrow involvement (71.9%). Independent predictors included thrombocytopenia at diagnosis (OR=2.09, P=0.037), BCR::ABL1(+) (OR=3.85, P=0.024), and positive MRD on day 19 (OR=2.09) and day 46 (OR=5.73, P<0.001) of induction therapy. Post-relapse, isolated extramedullary cases showed higher OS (100% vs. 72.9%, P=0.078) than bone marrow relapses. HSCT significantly improved OS in bone marrow relapse comparing to patients treated with chemotherapy or CAR-T alone (82.6% vs. 38.1%, P=0.027). Conclusion: Thrombocytopenia at diagnosis, BCR::ABL1(+), and persistent MRD are critical relapse predictors. HSCT remains pivotal for bone marrow relapse. Incorporating platelet counts into risk stratification and optimizing MRD-guided bridging therapies may enhance outcome. Future research should prioritize thrombocytopenia mechanisms and HSCT preconditioning strategies.
Keywords: Acute Lymphoblastic Leukemia, Immunothearpy, pediatric, prognosis, relapse
Received: 22 Sep 2025; Accepted: 03 Dec 2025.
Copyright: © 2025 Chen, Wu, Kuang, Wang, Hao, Jiang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Weina Zhang
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