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A novel prognostic nomogram for adult acute lymphoblastic leukemia: a comprehensive analysis of 321 patients

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Abstract

The cure rate of acute lymphoblastic leukemia (ALL) in adolescents and adults remains poor. This study aimed to establish a prognostic model for ≥14-year-old patients with ALL to guide treatment decisions. We retrospectively analyzed the data of 321 ALL patients between January 2017 and June 2020. Patients were randomly (2:1 ratio) divided into either the training or validation set. A nomogram was used to construct a prognostic model. Multivariate Cox analysis of the training set showed that age > 50 years, white blood cell count > 28.52×109/L, and MLL rearrangement were independent risk factors for overall survival (OS), while platelet count >37×109/L was an independent protective factor. The nomogram was established according to these independent prognostic factors in the training set, where patients were grouped into two categories: low-risk (≤13.15) and high-risk (>13.15). The survival analysis, for either total patients or sub-group patients, showed that both OS and progression-free survival (PFS) of low-risk patients was significantly better than that of high-risk patients. Moreover, treatment analysis showed that both OS and progression-free survival (PFS) of ALL with stem cell transplantation (SCT) were significantly better than that of ALL without SCT. Further stratified analysis showed that in low-risk patients, the OS and PFS of patients with SCT were significantly better than those of patients without SCT. In contrast, in high-risk patients, compared with non-SCT patients, receiving SCT can only significantly prolong the PFS, but it does not benefit the OS. We established a simple and effective prognostic model for ≥ 14-year-old patients with ALL that can provide accurate risk stratification and determine the clinical strategy.

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Data availability

Yuan-Zhong Chen had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Acknowledgements

We thank who have devoted a lot to this study, including nurses, pathologists, statisticians, reviewers, and editors.

Funding

This study was supported by the National Clinical Key Specialty of Hematology (Min 2023-48) and National and Fujian Provincial Key Clinical Specialty Discipline Construction Program of China, P. R.C.

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Author notes

  1. Qian Zhang, Mei-Juan Huang, and Han-Yu Wang contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou, China

    Qian Zhang, Mei-Juan Huang, Yong Wu & Yuan-Zhong Chen

  2. Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China

    Qian Zhang, Mei-Juan Huang, Yong Wu & Yuan-Zhong Chen

  3. Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China

    Han-Yu Wang

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Contributions

Qian Zhang, Yuan-Zhong Chen, and Yong Wu collection, management, analysis, and interpretation of the data; Qian Zhang, Mei-Juan Huang, Yong Wu, Han-Yu Wang, and Yuan-Zhong Chen preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Correspondence to Yong Wu or Yuan-Zhong Chen.

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This study was approved by the institutional review board of Fujian Medical University Union Hospital.

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Zhang, Q., Huang, MJ., Wang, HY. et al. A novel prognostic nomogram for adult acute lymphoblastic leukemia: a comprehensive analysis of 321 patients. Ann Hematol 102, 1825–1835 (2023). https://doi.org/10.1007/s00277-023-05267-6

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