A multicenter study on the prognostic value of prednisone response in pediatric acute lymphoblastic leukemia
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Prednisone response (PR) remains a key early treatment indicator in pediatric acute lymphoblastic leukemia (ALL). However, its independent prognostic significance has waned with the advent of minimal residual disease (MRD)-guided risk assessment. Evaluating the enduring biological and clinical significance of PR, especially in high-risk subtypes, could enhance the precision of therapeutic approaches. METHODS: This retrospective study analyzed clinical data from 2,979 pediatric patients primarily diagnosed with acute lymphoblastic leukemia (ALL) and enrolled in the South China Children's Leukemia Group (SCCLG-ALL)-2016 Collaborative Group between October 2016 and June 2023. Patients were categorized into "good prednisone response" (GPR) and "poor prednisone response" (PPR) groups based on their response to prednisone. Clinical characteristics were compared between groups using the chi-square test. Logistic regression was employed to analyze the correlation between prednisone response and early minimal residual disease (MRD). Survival analysis was performed using Kaplan-Meier curves, and prognostic factors were evaluated using Cox regression models. RESULTS: Among the 2,979 patients, 2,649 were categorized as GPR and 330 as PPR. Children in the PPR group exhibited multiple high-risk clinical features and had a poorer prognosis than those in the GPR group. However, multivariate Cox regression analysis revealed that days 15 and 33 MRD had a stronger predictive value than prednisone response. Notably, PR showed strong predictive value for MRD positivity on both Day 15 and Day 33. CONCLUSIONS: In this large real-world Chinese cohort, PR was not an independent prognostic marker but was strongly associated with early MRD burden. These findings support the contextual use of PR as a practical surrogate for MRD in resource-limited settings, and highlight the need to reconsider its role in modern risk-adapted treatment strategies.
Source: Annals of Hematology
Authors: Jia-Tong Dai, Yun-Yan He, Ya-Ting Zhang, Ya-Jie Zhang, Wu-Qing Wan, Wen-Guang Jia, Ming Cheng, Ying Liu, Yan-Lai Tang, Hui-Rong Mai, Shi-Lin Liu, Li-Li Liu, Ye-Sheng Ling, Qi-Wen Chen, Xing-Jiang Long, Liu-Hua Liao, Zi-Jun Zhen, Jian-Ling Cai, Qiao-Ru Li, Ya-Wei Zou, Li-Na Wang, Xian-Ling Kong, Yang Li, Ning Liao, Li-Na Wang
Institutions: Sun Yat-sen University, The First Affiliated Hospital, Sun Yat-sen University, Guangxi Medical University, First Affiliated Hospital of GuangXi Medical University, Sun Yat-sen Memorial Hospital, Zhujiang Hospital, Southern Medical University, Central South University, Second Xiangya Hospital of Central South University, Xiangya Hospital Central South University, Shenzhen Children's Hospital, Guangdong Medical College, Third Affiliated Hospital of Sun Yat-sen University, First Affiliated Hospital of Nanchang University, Huizhou Central People's Hospital, Sun Yat-sen University Cancer Center, First Affiliated Hospital of Shantou University Medical College, Zhongshan People's Hospital, First Affiliated Hospital of Guangzhou Medical University, Guangzhou First People's Hospital, Boai Hospital of Zhongshan
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,590
OpenAlex ID: W4415026319