Results in pediatric T‐ALL patients treated in trial AIEOP‐BFM ALL 2009: Prognostic factors in the context of modern risk‐adapted therapy
Bibliographic record
Abstract
Abstract To improve the outcome of pediatric T‐cell acute lymphoblastic leukemia (T‐ALL) patients, the AIEOP‐BFM ALL 2009 trial modified T‐ALL stratification and treatment based on AIEOP‐BFM ALL 2000 and other pediatric ALL groups' results. This report aims to describe the outcome of T‐ALL patients in trial AIEOP‐BFM ALL 2009 and evaluate prognostic features defined within the end of induction (EOI) therapy, for future protocols stratification and interventions. From 06/2010 to 02/2017, 872 T‐ALL patients, aged 1–17, were enrolled. High risk (HR) criteria were prednisone poor response (PPR), Day 15 flow cytometry minimal residual disease (MRD) ≥ 10%, no complete remission at EOI, or polymerase chain reaction (PCR)‐MRD ≥ 5 × 10 −4 at end of consolidation (EOC). Three Cox regression models on event‐free survival (EFS) evaluated prognostic factors. Overall, 5‐year EFS and survival were 79.9% ± 1.4% and 84.9% ± 1.2% with cumulative incidence of relapse (CIR) and death of 13.0% ± 1.2% and 5.9% ± 0.8%. Five‐year EFS and CIR were 86.8% ± 1.6% and 8.7% ± 1.3% in non‐HR patients ( n = 470); 71.9% ± 2.3% and 18.0% ± 1.9% in HR patients ( n = 402). High PCR‐MRD levels at EOI and EOC were prognostic in all models, with EOC‐MRD ≥ 5 × 10 −3 related to a hazard ratio of 6.22 (P < 0.001). When a model considered factors identified at EOI only, central nervous system (CNS)3 (hazard ratio = 2.3, P < 0.001), PPR (hazard ratio = 1.74, P = 0.02), and high EOI‐MRD (hazard ratio 4.71 for ≥5 × 10 −2 vs. negative, P < 0.001) significantly impacted EFS. Results of T‐ALL patients in AIEOP‐BFM ALL 2009 were favorable. While EOC‐MRD remained the strongest prognostic predictor, PPR, CNS3 disease, and EOI‐MRD showed relevant prognostic value, with CNS3 and EOI‐MRD ≥ 5 × 10 −2 being candidate criteria for early stratification and intervention modifications.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".