{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T05:55:36Z","timestamp":1763704536829},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2009,2,19]],"date-time":"2009-02-19T00:00:00Z","timestamp":1235001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2009,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite the poor outcome of recurrent or refractory acute lymphoblastic leukemia (ALL) in infants with <jats:italic>MLL<\/jats:italic> gene rearrangement, few studies have focused on this specific group. We conducted a retrospective analysis of infants with recurrent or refractory ALL from two previous consecutive Japanese studies to clarify the characteristics and prognostic factors among these patients<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>All recurrent or refractory ALL infants with <jats:italic>MLL<\/jats:italic> gene rearrangement (MLL\u2010R) who were registered in two consecutive Japanese nation\u2010wide multicentric trials (MLL96 and MLL98; between 1995 and 2001) were eligible for the study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 80 MLL\u2010R ALL infants, 34 cases of recurrence and 5 induction failures occurred. The median duration of first remission was 5 months (range, 0\u201328 months). All patients underwent various salvage chemotherapies; remission was achieved in 40.5% (15\/37). A total of 23 patients received subsequent hematopoietic stem cell transplantations (HSCT): 9 in remission, 12 without remission, and 2 with unknown status. With median follow\u2010up period of 5.5 years, the 5\u2010year overall survival (OS) rate after the second\u2010line treatment was 25.6%\u2009\u00b1\u20096.9%. Young age (&lt;3 months) and central nervous system involvement at initial diagnosis were associated with poor outcome; however, failure to achieve remission after salvage therapy was the sole independent poor prognostic factor in multivariate analysis (<jats:italic>P<\/jats:italic>\u2009=\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The prognosis of infants with recurrent or refractory MLL\u2010R ALL is extremely poor despite alternative treatments including HSCT; therefore, it is necessary to develop novel treatment strategies. Pediatr Blood Cancer 2009;52:808\u2013813. \u00a9 2009 Wiley\u2010Liss, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.21975","type":"journal-article","created":{"date-parts":[[2009,2,19]],"date-time":"2009-02-19T18:02:11Z","timestamp":1235066531000},"page":"808-813","source":"Crossref","is-referenced-by-count":42,"title":["Outcome of recurrent or refractory acute lymphoblastic leukemia in infants with <i>MLL<\/i> gene rearrangements: A report from the Japan infant leukemia study group"],"prefix":"10.1002","volume":"52","author":[{"given":"Daisuke","family":"Tomizawa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuyoshi","family":"Koh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Hirayama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takako","family":"Miyamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiki","family":"Hatanaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Saikawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiichi","family":"Ishii","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,2,19]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V94.4.1209"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-07-3011"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19971215)80:12<2285::AID-CNCR10>3.0.CO;2-Q"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61126-X"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2002.03754.x"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-04-1390"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2404903"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2401129"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2403253"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2007-01-067785"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V86.10.3861.bloodjournal86103861"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0145-2126(01)00072-8"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19980401)82:7<1387::AID-CNCR24>3.0.CO;2-1"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V101.10.3835"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2003.04584.x"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.01.1031"},{"key":"e_1_2_6_18_2","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1182\/blood.V78.5.1166.1166","article-title":"Six\u2010year experience with a comprehensive approach to the treatment of recurrent childhood acute lymphoblastic leukemia (ALL\u2010REZ BFM 85). 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