{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:18:01Z","timestamp":1787761081207,"version":"build-2784847793"},"reference-count":9,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood & Cancer"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Clinical risk group and early minimal residual disease (MRD) guide therapy for childhood B\u2010cell acute lymphoblastic leukemia (B\u2010ALL) but may not capture all molecular heterogeneity. We evaluated whether RNA sequencing (RNA\u2010seq) molecular risk classification improved outcome prediction under Chinese Children's Cancer Group (CCCG)\u2010acute lymphoblastic leukemia (ALL)\u20102020.<\/jats:p>\n <\/jats:sec>\n \n Procedure<\/jats:title>\n \n This retrospective cohort included 531 children with newly diagnosed B\u2010ALL treated at the Children's Hospital of Soochow University from 2020 to 2025. RNA\u2010seq subtypes were grouped as favorable, intermediate\/other, or adverse risk. The primary endpoint was standard event\u2010free survival (EFS). Real\u2010world EFS additionally counted treatment abandonment and non\u2010protocol discontinuation. Cox models and Harrell's\n C<\/jats:italic>\n \u2010index evaluated prognostic performance.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Favorable, intermediate\/other, and adverse molecular risk groups included 285, 152, and 94 patients, respectively. The 4\u2010year standard EFS and overall survival were 85.2% and 95.3%. In the integrated Cox model, compared with favorable molecular risk, intermediate\/other risk (hazard ratio [HR], 3.23; 95% confidence interval [CI], 1.58\u20136.60;\n p<\/jats:italic>\n \u00a0=\u00a00.001) and adverse risk (HR, 4.22; 95% CI, 1.94\u20139.17;\n p<\/jats:italic>\n \u00a0<\u00a00.001) were independently associated with inferior EFS. Adding Day\u201019 MRD and molecular risk group increased Harrell's\n C<\/jats:italic>\n \u2010index from 0.698 to 0.762. Under the real\u2010world EFS definition, adverse molecular risk remained associated with inferior outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n RNA\u2010seq molecular risk classification added prognostic information beyond protocol\u2010assigned clinical risk and early MRD in CCCG\u2010ALL\u20102020\u2010treated B\u2010ALL. These findings support prospective validation of transcriptomic risk assessment but do not establish RNA\u2010seq as a stand\u2010alone treatment\u2010allocation tool.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/1545-5017.70548","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T14:17:36Z","timestamp":1784902656000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["RNA\u2010seq Molecular Risk Classification Refines Prognostic Stratification in Childhood B\u2010Cell Acute Lymphoblastic Leukemia Treated With the CCCG\u2010ALL\u20102020 Protocol: A Real\u2010World Cohort Study"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0275-4324","authenticated-orcid":false,"given":"Yang","family":"Zhai","sequence":"first","affiliation":[{"name":"Department of Pediatric Hematology\/Oncology Children's Hospital of Soochow University Suzhou Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology\/Oncology Children's Hospital of Soochow University Suzhou Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingjun","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology\/Oncology Children's Hospital of Soochow University Suzhou Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.59.1636"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1400972"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2020.247031"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41588\u2010018\u20100315\u20105"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41588\u2010022\u201001159\u2010z"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1158\/2643\u20103230.BCD\u201020\u20100229"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021005894"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2023.283706"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097\u20100258(19960229)15:4<361::AID\u2010SIM168>3.0.CO;2\u20104"}],"container-title":["Pediatric Blood & Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1545-5017.70548","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/1545-5017.70548","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1545-5017.70548","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:18:49Z","timestamp":1787757529000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/1545-5017.70548"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":9,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/1545-5017.70548"],"URL":"https:\/\/doi.org\/10.1002\/1545-5017.70548","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]},"assertion":[{"value":"2026-06-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70548"}}