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The pretreatment characteristics of 158 children with previously untreated acute lymphoblastic leukemia diagnosed April 1972 to June 1978 were analyzed for their ability to predict prognosis. The children were treated according to therapeutic protocols 721, 745 and 765, by members of the Japanese Children's Cancer and Leukemia Study Group. A univariate analysis was performed to determine the relationship between the characteristics and the duration of the patients' survival. The following characteristics were analyzed: initial white blood cell (WBC) count, age at diagnosis, initial hemoglobin level, initial platelet count, sex, organomegaly, and treatment regimen that was provided. Favorable prognosis was exhibited only by those patients with initial WBC counts of less than 50,000/mm3, with age at onset between 2 and 6 years, without splenomegaly, and with hemoglobin levels between 5 and 10 g/dl. The most significant contributions among the various individual prognostic factors were initial WBC count (p less than 0.001) and the age at diagnosis (p less than 0.01).

This Japanese nation-wide survey was carried out on long-term survivors among children with leukemia, i.e. those who had survived more than 5 years by October of 1974. Eighty-three children were surveyed. This was about 2.5 times as many as the 31 children surveyed in the first Japanese nation-wide survey in 1971. Clinical and laboratory data were also analyzed statistically and compared to that of the first survey. Most of the children had received inductive therapy according to the old protocol, but 10 children were treated with a combination of VCR and steroids. Nine of these 10 were still in a state of remission. CNS involvement occurred in 15.3% of the cases and a late onset of this complication implied a prognostic significance: among the 9 children whose complication had occurred 3.5 years after onset of the disease, 6 died. The relapse rate decreased between the 4th and 5th year after initiation of maintenance therapy. The percentage of the risk of death became zero after the 9th year.

Four criteria for the risk grouping of children's acute lymphoblastic leukemia: Children's Cancer and Leukemia Study Group (CCLSG) in Japan, Southwest Oncology Group (SWOG) and Children's Cancer Study Group (CCG-141) in the USA, Berlin-Frankfurt-Münster Study Group (BFM) in West Germany, were applied retrospectively to 109 patients with the disease who had been treated randomly in Sapporo National Hospital from 1978 to 1986. No significant difference in respect of survival curve was found in most combinations between low- and intermediate-risk groups, nor among either low- or intermediate-risk groups (P greater than 0.10, Cox-Mantel's test). Among the four high-risk groups formed by the application of these criteria, no significant difference was noted (P greater than 0.10), but there were significant differences between the high-risk and the low- or intermediate-risk groups (P less than 0.05 or 0.10). With such results, a comparison of therapeutic results in high-risk groups yielded by different study groups would appear to be not only possible but useful, for example, in improving therapeutic methods.

The pretreatment characteristics of 158 children with previously untreated acute lymphoblastic leukemia diagnosed April 1972 to June 1978 were analyzed for their ability to predict prognosis. The children were treated according to therapeutic protocols 721, 745 and 765, by members of the Japanese Children's Cancer and Leukemia Study Group. Multivariate analysis was performed to determined the relationship between the characteristics and duration of survival of the patients. The following characteristics were analyzed: initial white blood cell (WBC) count, age at diagnosis, initial hemoglobin level, initial platelet count, sex, organomegaly, and treatment regimen that was provided. By using multivariate techniques, factors were found which the independently and significantly predict the length of survival. These factors were initial WBC count (r0 = 0.2908), age at diagnosis (r0 = 0.2982), and treatment regimen (r0 = 0.2488). Using the major prognostic factors of age at diagnosis and initial WBC count, a formula to predict the survival time was established. According to the initial WBC count and age at diagnosis, we classified all cases of childhood ALL as standard risk and high risk.