{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:38:13Z","timestamp":1789609093488,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,1,8]],"date-time":"2022-01-08T00:00:00Z","timestamp":1641600000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with T\u2010cell acute lymphoblastic leukemia and lymphoma (T\u2010ALL\/LLy) commonly present with critical features such as hyperleukocytosis and mediastinal mass, which complicates completing a diagnostic and staging workup and prevents clinical trial enrollment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>Consecutive patients with T\u2010ALL\/LLy from 1999 to 2019 at the Children's Hospital of Philadelphia were analyzed for pediatric intensive care unit (PICU) admission and various high\u2010risk features as well as clinical trial enrollment and outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 153 patients newly diagnosed with T\u2010ALL\/LLy, 53 (35%) required PICU\u2010level care within 24\u00a0hours and 73 (48%) within 7 days. Non\u2010PICU patients had a significantly higher clinical trial enrollment rate (79.4%) versus PICU patients (56.1%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.016). Patients who enrolled on a clinical trial had similar relapse risk to those who did not enroll (relapse rate 20%\u00a0vs 29%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.523). Nineteen patients were precluded from trial participation. Risk of relapse was increased for patients admitted to the PICU within 24\u00a0hours (26%\u00a0vs 13%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.048). Forty\u2010four patients with T\u2010ALL presented with hyperleukocytosis, of which 30% relapsed versus 14% without (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.082). Patients who underwent apheresis for hyperleukocytosis were statistically more likely to relapse (47%\u00a0vs 15%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.007). Patients with elevated uric acid (20%\u00a0vs 16%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.278), mediastinal mass (20%\u00a0vs 14%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.501), or required emergent steroids (20%\u00a0vs 16%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.626) had a similar relapse risk. A single second relapse patient survived.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Almost half of T\u2010ALL\/LLy patients required PICU\u2010level care at diagnosis, making enrollment on clinical trials challenging, but trial enrollment predicted better outcome. Physicians should balance maintaining eligibility with safety to offer patients all options.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29457","type":"journal-article","created":{"date-parts":[[2022,1,8]],"date-time":"2022-01-08T12:09:32Z","timestamp":1641643772000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Outcomes of children and young adults with T\u2010cell acute lymphoblastic leukemia\/lymphoma who present in critical status"],"prefix":"10.1002","volume":"69","author":[{"given":"Nicole J.","family":"Wayne","sequence":"first","affiliation":[{"name":"Perelman School of Medicine  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yimei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics University of Pennsylvania  Philadelphia Pennsylvania"},{"name":"Division of Oncology and Center for Childhood Cancer Research Children's Hospital of Philadelphia  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Perry","family":"Chung","sequence":"additional","affiliation":[{"name":"Division of Oncology and Center for Childhood Cancer Research Children's Hospital of Philadelphia  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Coffan","sequence":"additional","affiliation":[{"name":"Division of Oncology and Center for Childhood Cancer Research Children's Hospital of Philadelphia  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8025-6767","authenticated-orcid":false,"given":"Susan R.","family":"Rheingold","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine  Philadelphia Pennsylvania"},{"name":"Division of Oncology and Center for Childhood Cancer Research Children's Hospital of Philadelphia  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1400972"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1309\/2QE3A6EKQ8UYDYRC"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.37.8018"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.77.7250"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00531"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2009.256"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2016.1.580"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.10164"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.5045\/br.2014.49.1.29"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/10245332.2017.1333294"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI130189"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1203\/00006450-197404000-00406"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12042"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.15793"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2017.08.003"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1040-1741(09)79345-5"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12308-014-0200-9"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13160"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2012.01.003"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2018.02.006"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.15159"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-005-2647-8"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/1073274818773720"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2013.31.15_suppl.10003"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2019.37.15_suppl.6564"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2008.251"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-07-294678"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.03.426"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2010.08236.x"}],"container-title":["Pediatric Blood &amp; 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