Korean J Hematol.  2008 Dec;43(4):238-246. 10.5045/kjh.2008.43.4.238.

Effect of Treatment Modification by the Initial Response in Patients with High-Risk Childhood Acute Lymphoblastic Leukemia

• Yoon JH
• Kim EK
• Park JA
• Kang HJ
• Shin HY
• Ahn HS

• KMID: 1485082
• DOI: http://doi.org/10.5045/kjh.2008.43.4.238

Abstract

BACKGROUND: The bone marrow (BM) findingd on day 7 of induction chemotherapy is one of major prognostic factors for patients with acute lymphoblastic leukemia (ALL). M3 marrow (blast >25% on BM examination) on day 7 is associated with lower survival rates, compared with the M1 (blast <5%) or M2 (blast 5~25%) marrow. Herein, we analyzed the effect of augmented post-induction chemotherapy in patients who have high-risk ALL with M3 marrow on the day 7 BM examination.
METHODS
We analyzed the patients who were diagnosed with high-risk ALL and they received modified Children's Cancer Group (CCG)-1882 induction chemotherapy between January 1996 and October 2005 at Seoul National University Children's Hospital. The patients with M1 or M2 marrow on day 7 were treated with modified CCG-1882A/B chemotherapy from consolidation, and the patients with M3 marrow were treated with modified CCG-1882C chemotherapy.
RESULTS
A total of 44 patients (29 with modified CCG-1882A/B and 15 with modified CCG-1882C) were analyzed. The overall survival (OS) and 5-year event-free survival (EFS) were 86.2% and 81.9%, respectively. The OS of the patients who were treated with the modified CCG-1882A/B protocol (88.9%) was not different from that of the patients who were treated with the modified CCG-1882C protocol (80.0%) (P=0.3256). Also, there was no statistical difference in the 5-year EFS of both groups (85.4% vs 72.7%, respectively, P=0.2117).
CONCLUSIONS
There was no difference of survival between the patients with M1/M2 marrow on the day 7 BM examination and those with M3 marrow after augmented post-induction chemotherapy for the patient with high-risk ALL. We suggest that the poor prognosis of high-risk ALL patients with a poor initial response could be overcome by augmented post-induction chemotherapy.

Keyword

High-risk acute lymphoblastic leukemia; Augmented post-induction chemotherapy; Childhood; Response; Prognosis; Survival rate

MeSH Terms

Bone Marrow
Disease-Free Survival
Humans
Induction Chemotherapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Prognosis
Survival Rate

Figure

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  Fig. 1 Overall survival (A) and event-free survival (B) in all patients.

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  Fig. 2 Overall survival (A) and event-free survival (B) in both groups of post-induction treatment protocols. There was no statistical difference in overall survival (P=0.3256) and event-free survival (P=0.2117) of both groups.

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