{
  "abstract": "Outcomes in pediatric acute lymphoblastic leukemia (ALL) have improved substantially with contemporary risk-adapted therapy. However, the prognosis for historically high-risk subtypes, including KMT2A -rearranged ( KMT2A -r) and hypodiploid ALL, remains uncertain. We performed a post hoc analysis of 28 patients with KMT2A -r ALL and 27 with hypodiploid ALL enrolled in the nationwide Japan Children’s Cancer Group ALL-B12 trial to characterize early treatment response, measurable residual disease (MRD) kinetics, transplant exposure, and clinical outcomes. The 5-year event-free and overall survival were 85.7% and 89.3% for KMT2A -r ALL and 85.2% and 85.2% for hypodiploid ALL, respectively. Clinical behavior was heterogeneous within each subtype. In KMT2A :: AFF1 ALL, prednisolone poor response or persistent MRD was associated with a high risk of relapse despite hematopoietic stem cell transplantation (HSCT). Even among prednisolone good responders, patients with MRD ≥10 –3 at time point 1 remained at increased risk of relapse, whereas those with MRD ≥10 –4 but <10 –3 generally showed favorable outcomes. In contrast, non- AFF1 KMT2A -r patients demonstrated rapid MRD clearance and excellent survival. Among patients with hypodiploid ALL, those with low-diploid ALL showed excellent outcomes without HSCT. In other hypodiploid subgroups, some patients with favorable early response achieved long-term survival without transplantation. These findings suggest that historically high-risk ALL subtypes are clinically heterogeneous and that early response kinetics may help refine risk stratification and treatment intensification strategies, including indications for HSCT.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan",
    "Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan",
    "Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan",
    "Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan",
    "Department of Medical Technology, Kyorin University Faculty of Health Sciences, Mitaka, Japan",
    "Department of Hematology and Oncology, Saitama Prefectural Children’s Medical Center, Saitama, Japan",
    "Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Correspondence: Motohiro Kato, Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan;"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yasuo Kubota"
    },
    {
      "affs": [
        1
      ],
      "name": "Yasuhiro Okamoto"
    },
    {
      "affs": [
        2
      ],
      "name": "Toshihiko Imamura"
    },
    {
      "affs": [
        3
      ],
      "name": "Akiko Kada"
    },
    {
      "affs": [
        3
      ],
      "name": "Akiko M. Saito"
    },
    {
      "affs": [
        3
      ],
      "name": "Yuka Iijima-Yamashita"
    },
    {
      "affs": [
        3
      ],
      "name": "Masashi Sanada"
    },
    {
      "affs": [
        4
      ],
      "name": "Tomohiko Taki"
    },
    {
      "affs": [
        5
      ],
      "name": "Katsuyoshi Koh"
    },
    {
      "affs": [
        6
      ],
      "name": "Motohiro Kato"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/57ft0a69twye8.bib",
  "cited_by": 0,
  "doi": "10.1016/j.bneo.2026.100313",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2950328026001251",
  "id": "57ft0a69twye8",
  "issns": [
    "2950-3280"
  ],
  "landing_url": "https://doi.org/10.1016/j.bneo.2026.100313",
  "language": "en",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Lymphoid Neoplasia"
    ],
    [
      "lcc",
      "RC633-647.5"
    ],
    [
      "openalex",
      "2739|Acute Lymphoblastic Leukemia research"
    ]
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  "openalex": "W7213671283",
  "pdf_url": "https://www.sciencedirect.com/science/article/pii/S2950328026001251/pdf",
  "pmcid": "PMC13718581",
  "pmid": "42960217",
  "published": "2026-09-19",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/57ft0a69twye8.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:20Z",
      "native_id": "07564c706f5d4807b7a7560aa4399bc5",
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    {
      "first_seen": "2026-10-31T00:20:39Z",
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    {
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Acute Lymphoblastic Leukemia research",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Refining risk in historically high-risk pediatric B-cell acute lymphoblastic leukemia: response kinetics and outcomes",
  "title_text": "Refining risk in historically high-risk pediatric B-cell acute lymphoblastic leukemia: response kinetics and outcomes",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:22:35Z",
  "url": "https://research.draconitic.com/paper/57ft0a69twye8",
  "venue": "Blood Neoplasia",
  "versions": []
}