Cessation of therapy in chilhood acute lymphoblastic leukemia / Suspension de la terapia de leucemia limfoblastica aguda en niños

RESUMEN

Two hundred and seventy patients with Acute Lymphoblastic Leukaemia in the pediatric age were studied and treated during 1969-1993 with different therapeutical shemes which virtually all included in the protocols of the Latin America Group for the Treatment of Malignant Hemopathics (GLATEM). These patients have been treated in different hospitals of Cuba, and most of them were in first complete remission. Of the total of patients, 8 have been treated before GLATEM protocols; 92 were treated with schemes of the 70s and the remaining ones oncluded in more recent protocols. treatment, and they were followed during several years with clinical and hematological control. Prognostic group classification was carried out mainly in relation to age and leukocyte count., consideranting thre groups: Good, Intermediate and Poor. Percentage of relapse, site, and time of occurrence are discussed, and they are related to pronostic factors at the beginning of the dosease. Fourty-two (15.5 por ciento) patients have relapsed, mainly in bone marrow during an observation period of 0-21 years off therapy (mean 8 years). Half of relapses occurred during the first year following of therapy and only two after 4 years off therapy, which represents 1por ciento of all patients. More late relapses significantly occurred in male patients and in patients with notable hepatomegaly at the beginning of the disease. Survival probability form the whole group is 90 per cent al 5 years and 84 per cent at 10 years after cessation of therapy. For patients relapsing off therapy, probability of survival in 5 years is 53 per cent. The CNS relapses being of the best course and those of bone marrow of the most unfavorable one. An import number of patients had their therapy stopped a second time. The hihg number of patients, event-free for several years without treatment; show that true cures can be attained in ALL children