Salvage treatment incorporating arsenic trioxide for pediatric relapsed acute lymphoblastic leukemia: a retrospective real-world analysis
Abstract
BackgroundRelapsed pediatric acute lymphoblastic leukemia (ALL) confers an unfavorable prognosis. We evaluated the outcomes of an arsenic trioxide (ATO)-incorporating chemotherapy protocol in pediatric first-relapsed ALL.MethodsPatients were risk-stratified according to the ALL-REZ BFM 2002 protocol. Group A received an institutional ATO-containing protocol at one university-affiliated hospital between September 2010 and September 2021, while Group B followed the ALL-REZ BFM 2002 protocol at another one in the same city during the similar period.ResultsGroup A comprised 43 patients, 9 high-risk, among whom one (11.1%) underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). Group B had 35 patients with 15 high-risk among whom 7 (46.7%) received allo-HSCT. In non-high-risk patients, 5-year event-free survival (EFS) was comparable between groups (73.5% vs 70.0%, P = 0.794). Among high-risk patients, EFS was higher in Group A (44.4% vs 13.3%, P = 0.048). Moreover, Group A remained independently associated with better EFS in a multivariable Cox model incorporating allo-HSCT as a time-dependent covariate (HR = 0.50, 95% CI: 0.25-0.99, P = 0.048).ConclusionHigh-risk relapsed ALL stratified by the ALL-REZ BFM 2002 stratification system carries a poor prognosis. The incorporation of ATO into salvage regimens merits further investigation, and prospective randomized controlled trials would help confirm its promising prognostic advantages.
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BibTeX
@article{li2026salvage,
title = {{Salvage treatment incorporating arsenic trioxide for pediatric relapsed acute lymphoblastic leukemia: a retrospective real-world analysis}},
author = {Jia-Nan Li and Ji-Xun Lin and Cui-Yun Yang and Ke Huang and Yan-Lai Tang and Li-Bin Huang and Jian Wang and Zhong Fan and Dan-Ping Huang and Li-Dan Zhang and Qiao-Ru Li and Zhi-Yong Ke and Dun-Hua Zhou and Hong-Man Xue and Xue-Qun Luo},
journal = {Frontiers in Oncology},
year = {2026},
month = nov,
doi = {10.3389/fonc.2026.1987372},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1987372},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Salvage treatment incorporating arsenic trioxide for pediatric relapsed acute lymphoblastic leukemia: a retrospective real-world analysis
AU - Jia-Nan Li
AU - Ji-Xun Lin
AU - Cui-Yun Yang
AU - Ke Huang
AU - Yan-Lai Tang
AU - Li-Bin Huang
AU - Jian Wang
AU - Zhong Fan
AU - Dan-Ping Huang
AU - Li-Dan Zhang
AU - Qiao-Ru Li
AU - Zhi-Yong Ke
AU - Dun-Hua Zhou
AU - Hong-Man Xue
AU - Xue-Qun Luo
PY - 2026
DA - 2026/11/09
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1987372
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1987372
AB - BackgroundRelapsed pediatric acute lymphoblastic leukemia (ALL) confers an unfavorable prognosis. We evaluated the outcomes of an arsenic trioxide (ATO)-incorporating chemotherapy protocol in pediatric first-relapsed ALL.MethodsPatients were risk-stratified according to the ALL-REZ BFM 2002 protocol. Group A received an institutional ATO-containing protocol at one university-affiliated hospital between September 2010 and September 2021, while Group B followed the ALL-REZ BFM 2002 protocol at another one in the same city during the similar period.ResultsGroup A comprised 43 patients, 9 high-risk, among whom one (11.1%) underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). Group B had 35 patients with 15 high-risk among whom 7 (46.7%) received allo-HSCT. In non-high-risk patients, 5-year event-free survival (EFS) was comparable between groups (73.5% vs 70.0%, P = 0.794). Among high-risk patients, EFS was higher in Group A (44.4% vs 13.3%, P = 0.048). Moreover, Group A remained independently associated with better EFS in a multivariable Cox model incorporating allo-HSCT as a time-dependent covariate (HR = 0.50, 95% CI: 0.25-0.99, P = 0.048).ConclusionHigh-risk relapsed ALL stratified by the ALL-REZ BFM 2002 stratification system carries a poor prognosis. The incorporation of ATO into salvage regimens merits further investigation, and prospective randomized controlled trials would help confirm its promising prognostic advantages.
SN - 2234-943X
ER -