RNA‐seq Molecular Risk Classification Refines Prognostic Stratification in Childhood B‐Cell Acute Lymphoblastic Leukemia Treated With the CCCG‐ALL‐2020 Protocol: A Real‐World Cohort Study
Real-world cohort study evaluates RNA-seq classification for predicting outcomes in pediatric B-ALL, highlighting molecular risk's importance.
Key Points
This study aims to evaluate if RNA-seq molecular risk classification improves outcome prediction in childhood B-ALL treated under the CCCG-ALL-2020 protocol.
Retrospective cohort study including 531 newly diagnosed B-ALL children treated at Children's Hospital of Soochow University from 2020 to 2025.
Patients grouped into favorable, intermediate/other, or adverse molecular risk categories based on RNA-seq results.
Cox models and Harrell's C-index used to assess prognostic performance.
4-year event-free survival was 85.2%, with significant differences in survival based on molecular risk classification.
Intermediate/other risk group showed HR of 3.23 (95% CI 1.58-6.60; p=0.001) and adverse risk showed HR of 4.22 (95% CI 1.94-9.17; p<0.001) compared to favorable risk.
Harrell's C-index improved from 0.698 to 0.762 by adding Day-19 MRD and molecular risk group.