The prognostic significance of hematogonesin childhood B-cell Acute Lymphoblastic Leukemia

Background: Hematogones (HGs) are normal B-lymphocyteprecursors more commonly found in pediatric bone marrow.Recent studies have demonstrated HGs expansion to be associatedwith favorable outcomes in hematological diseases, especiallyin patients with acute myeloid leukemia (AML) andpatients undergoing hematopoietic stem cell transplantation.Acute lymphoblastic leukemia (ALL) is the most commonform of cancer in children. As of now, minimal residual disease(MRD) remains the most compelling independent prognosticfactor in childhood ALL. There is need for more prognostic tools for evaluating relapse risk. The goal of current study wasto evaluate the impact of HGs in childhood ALL on relapsefreesurvival (RFS) and overall survival (OS) controlling formultiple factors.Materials and Methods: This prospective cohort study wasconducted from ۲۰۱۷ to ۲۰۲۳ in Omid hospital, a referral oncologyhospital affiliated with Isfahan University of MedicalSciences. ۱۲۲ patients with B-cell line ALL who met the inclusioncriteria were recruited using consecutive sampling. ۴-colorflow cytometric HGs and MRD detection was performed inbone marrow aspiration after induction and consolidationtherapy. HGs were identified with the characteristic profileand expression manner of CD۲۰, CD۱۰, CD۱۹, CD۳۸ in lowexpression CD۴۵ gate. Moreover, chromosomal studies wereconducted on BM samples. Evaluated abnormalities included:t(۱۲;۲۱) ETV۶-RUNX۱ , t(۱;۱۹) TCF۳-PBX۱, t(۹;۲۲) BCRABL۱and t(v;۱۱q۲۳.۳) KMT۲A-rearranged.Results: The median follow-up period of patients was ۳۵.۵۰months. ۵ (۸.۸%) out of ۵۷ HG positive patients had a relapse,compared to ۱۷ (۲۶.۲%) of ۶۵ HG negative patients, which wasa statistically significant difference (p=۰.۰۱۳). RFS was ۷۳.۸%in HG- and ۹۱.۲% in HG+ (at least ۱.۰% HGs) patients, whichwas statistically significant (p=۰.۰۲۳ by log-rank). Moreover,univariate and multivariate cox regression analysis confirmedthat positive HGs was independently associated with longerRFS (unadjusted model: HR=۰.۳۳, ۹۵%CI=۰.۱۲-۰.۹۱, p=۰.۰۳۱;adjusted model: HR=۰.۳۰, ۹۵%CI=۰.۱۱-۰.۸۲, p=۰.۰۲۰).Conclusion: Our study clearly shows the significance of HGsas an independent prognostic factor. The results indicate the independentprognostic value of HGs on RFS after adjustment forother prognostic factors and can be beneficial for risk stratificationand treatment modifications amongst pediatric B-cell ALLpatients.

کلیدواژه ها:

Hematogones ، Acute Lymphoblastic Leukemia ، Hematology ، Immunophenotyping ، Prognosis