Published online 24 September 2008
Haematologica, Vol 93, Issue 11, 1652-1657 doi:10.3324/haematol.13156
Copyright © 2008 by Ferrata Storti Foundation
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Original Articles

Anemia and survival in childhood acute lymphoblastic leukemia

Oliver Teuffel1, Martin Stanulla2, Gunnar Cario3, Wolf D. Ludwig4, Silja Rottgers5, Beat W. Schafer1, Martin Zimmermann2, Martin Schrappe3, Felix K. Niggli1

1 University Children’s Hospital Zurich, Zurich, Switzerland
2 Children’s Hospital, Hannover Medical School (MHH), Hannover, Germany
3 Children’s Hospital, University Medical Center Schleswig-Holstein, Kiel, Germany
4 Robert-Rossle-Clinic, HELIOS Klinikum Berlin-Buch and
5 University Children’s Hospital, Giessen, Germany

Correspondence: Felix Niggli, MD, University Children’s Hospital Zurich, Steinwiesstrasse 75 Zurich, 8032 Switzerland., E-mail:felix.niggli{at}kispi.uzh.ch

Background: Several studies have demonstrated that patients with childhood acute lymphoblastic leukemia presenting with mild anemia at diagnosis have an increased risk of poor outcome compared to patients with more severe anemia. However, it has not been reported whether there is any correlation between degree of anemia and leukemia subtype.

Design and Methods: In a cohort of 1162 patients with childhood acute lymphoblastic leukemia we analyzed whether there was a correlation between degree of anemia and leukemia subtype. We also studied the association between degree of anemia and event-free survival within the subtypes.

Results: Hemoglobin levels at diagnosis were distributed in a non-random pattern. The degree of anemia was significantly different for three distinct groups of patients compared to the remaining patients (mean hemoglobin; T-cell leukemia: 106 g/L versus 76 g/L (precursor B-cell acute lymphoblastic leukemia); within precursor B-cell ALL: TEL-AML1 positive: 68 g/L versus 79 g/L; BCR-ABL positive: 93 g/L versus 76 g/L; each p<0.05). Furthermore, in contrast to the entire study group, patients with T-cell leukemia, TEL-AML1+, and BCR-ABL+ precursor B-cell leukemia had a more favorable prognosis if presenting with a higher hemoglobin level (≥80 g/L).

Conclusions: These observations indicate that the formerly reported direct correlation between severity of anemia and survival in childhood acute lymphoblastic leukemia mainly reflects differences in the degree of anemia between distinct biological subgroups with different treatment outcomes. On the other hand, the inverse relationship between severity of anemia and survival found within specific subgroups suggests that very low hemoglobin levels at diagnosis are associated with more advanced disease in these subgroups.

Key words: childhood acute lymphoblastic leukemia, anemia, myeloid suppression, TEL-AML1.