ABSTRACT
In the past 16 years, 2004 children with acute lymphoblastic leukemia (ALL) have been treated in the Polish Pediatric Group centers. Eight hundred and eighty-seven (44.3%) of these patients discontinued treatment after the first remission. Acute lymphoblastic leukemia relapse occurred in 180 patients (20.3%). This group was analyzed for the method of treatment and its influence on long-term survival, the time between cessation of treatment and relapse, the character and localization of relapse and later follow-up. It was shown that the patients with the best chance of a second remission are those with late testicular relapse. The most frequent and prognostically poor are bone marrow (BM) relapses which warrant intensive chemotherapy with BM transplantation. Patients with ALL relapse still have the possibility of a second remission and long-term survival.
Subject(s)
Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Asparaginase/administration & dosage , Child , Child, Preschool , Daunorubicin/administration & dosage , Female , Humans , Infant , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality , Prednisone/administration & dosage , Prognosis , Recurrence , Survival Rate , Vincristine/administration & dosageABSTRACT
Within the past 16 years, 2004 children with the acute lymphoblastic leukemia were treated at the Centres of the Polish Pediatric Study Group. The treatment was completed in 887 patients (44.3%) with the first remission. Recurrence was noted in 180 children (20.3%). This group was analysed in view of the type of therapy and its effect on the survival rate, significance of recurrence following therapy, character and localization of recurrent disease, and further fate of patients. It was found, that patients with isolated late nuclear recurrence have greatest chances to achieve subsequent remission. Most frequent and severe is recurrent bone marrow involvement which requires intensive chemotherapy combined with bone marrow transplantation due to unfavourable prognosis. Patients with the first recurrence of the acute lymphoblastic leukemia have a chance to achieve subsequent remission and long-term survival.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Neoplasm Recurrence, Local/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Adolescent , Asparaginase/administration & dosage , Child , Child, Preschool , Cyclophosphamide/administration & dosage , Daunorubicin/administration & dosage , Female , Humans , Male , Methotrexate/administration & dosage , Neoplasm Recurrence, Local/etiology , Neoplasm Recurrence, Local/mortality , Prednisone/administration & dosage , Prognosis , Remission Induction , Time Factors , Vincristine/administration & dosageABSTRACT
In the group of 63 children in whom a relapse of ALL after first suspension of treatment occurred, and in whom a repeated cessation of therapy had place, 46.2% of patients had probability of a prolonged symptomless survival. The children with an isolated extramedullary relapse had a greater chance for a DFS of 7 years, than those with a relapse in the bone marrow (p = 0.05). The patients with a relapse occurring after the first cessation of treatment of ALL should be treated as intensively as newly diagnosed cases, because they have a real possibility for a prolonged survival during remission phase of disease.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Neoplasm Recurrence, Local/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Asparaginase/administration & dosage , Child , Child, Preschool , Cyclophosphamide/administration & dosage , Daunorubicin/administration & dosage , Female , Humans , Infant , Male , Methotrexate/administration & dosage , Neoplasm Recurrence, Local/mortality , Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality , Prednisone/administration & dosage , Remission Induction , Time Factors , Vincristine/administration & dosageABSTRACT
Among 1879 children with the diagnosis of acute lymphoblastic leukaemia made up to Dec 31 1987 in 863 cases (45.92%) treatment was discontinued. They were followed up till Dec 31 1989. The median follow-up was 3 years and 14 months. In 811 cases the treatment was discontinued during the first complete remission, in 56 cases after a relapse during initial treatment. In the time period when the programmes St. Jude and LSA2L2 were used the per cent of children with treatment withdrawal was 38.22%, but it rose to 53.01% when a more intensive programme BMF had been introduced. The probability of 7-year disease free survival after treatment discontinuation was 69.5% and 76.2% respectively. In 186 cases (21.6%) relapses developed., mostly in the first year after treatment discontinuation, but even after 7 years the risk of relapse was 2.46%. Ninety-six children (11.2%) died, 761 (88.8%) are alive, among them 671 in the first complete remission. Apart from therapy intensity, a statistically significant beneficial effect on disease free survival had discontinuation of treatment during the first complete remission, and sex--the prognosis was better in girls. In three cases secondary neoplasms were found.
