{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:43:30Z","timestamp":1777945410871,"version":"3.51.4"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Shenzhen Medical Research Fund","award":["A2402007"],"award-info":[{"award-number":["A2402007"]}]},{"DOI":"10.13039\/501100003785","name":"Guangdong Medical Research Foundation","doi-asserted-by":"publisher","award":["A2024559"],"award-info":[{"award-number":["A2024559"]}],"id":[{"id":"10.13039\/501100003785","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Guangdong Administration of Traditional Chinese Medicine","award":["20261054"],"award-info":[{"award-number":["20261054"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Med Oncol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite high cure rates in pediatric B-cell acute lymphoblastic leukemia (B-ALL), relapse remains a major challenge. Current risk stratification systems fail to identify a subset of occult high-risk (HR) patients. Transferrin receptor 1 (CD71), a key regulator of iron uptake, is often overexpressed in aggressive tumors; however, its independent prognostic value in pediatric B-ALL has not been fully elucidated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To evaluate the independent prognostic significance of CD71 expression in a large cohort of pediatric B-ALL patients and to determine its utility in identifying HR subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A retrospective, multicenter cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We analyzed 1207 pediatric B-ALL patients treated under the South China Children\u2019s Leukemia Group-ALL-2016 protocol between January 2016 and June 2023 across 20 centers in Southern China. CD71 expression was assessed by flow cytometry at diagnosis, with positivity defined as \u2a7e20% expression on blast cells. We analyzed associations between CD71 status, clinical characteristics, and survival outcomes using Kaplan\u2013Meier methods and multivariate Cox regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      CD71 positivity was rare in B-ALL (1.0%) compared to T-ALL (15.6%). Clinically, CD71-positive B-ALL patients presented with significantly lower initial white blood cell (WBC) counts (median 4.0 vs 10.0\u2009\u00d7\u200910\n                      <jats:sup>9<\/jats:sup>\n                      \/L,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.015). Despite this lower peripheral tumor burden, CD71 positivity was associated with extremely poor outcomes. The 5-year cumulative incidence of relapse (CIR) was significantly higher in the CD71-positive group compared to the negative group (39.4% vs 10.1%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.004). Multivariate analysis confirmed that CD71 positivity is an independent risk factor for relapse (hazard ratio (HR)\u2009=\u20095.94,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.003) and adverse events (HR\u2009=\u20094.868, 95% confidence interval: 1.512\u201315.671,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.008), irrespective of age, WBC, genetic subtype, or minimal residual disease status.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>CD71 expression identifies a rare but biologically distinct B-ALL subgroup characterized by aggressive behavior despite low initial WBC counts. These findings indicate that the inclusion of CD71 in diagnostic panels may help to optimize current risk stratification systems, serving as a critical tool to recognize occult HR patients who might otherwise be under-stratified by conventional prognostic markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration:<\/jats:title>\n                    <jats:p>\n                      The trial is registered with the Chinese Clinical Trial Registry (Chi-CTR;\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.chictr.org.cn\/\">https:\/\/www.chictr.org.cn\/<\/jats:ext-link>\n                      ; number ChiCTR2000030357; Registration date: February 29, 2020).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17588359261445060","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T11:29:26Z","timestamp":1777548566000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["CD71 as an independent prognostic factor in pediatric B-ALL: a regional multicenter retrospective study in Southern China (SCCLG-ALL-2016)"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1833-1478","authenticated-orcid":false,"given":"Xing-Fei","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Guang","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Second Xiangya Hospital, Central South University, Changsha, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Li","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xing-Jiang","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Liuzhou People\u2019s Hospital, Liuzhou, Guangxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Hua","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, 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China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Na","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Guangzhou First People\u2019s Hospital, Guangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nan","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zi-Jun","family":"Zhen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 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