J Korean Med Sci.  2009 Apr;24(2):281-288. 10.3346/jkms.2009.24.2.281.

Improvement of Induction Remission Rate by Modifying the Dose of Idarubicin for Relapsed Childhood Acute Lymphoblastic Leukemia

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

• KMID: 1779131
• DOI: http://doi.org/10.3346/jkms.2009.24.2.281

Abstract

Relapse is the major cause of treatment failure in acute lymphoblastic leukemia (ALL), yet there is no established treatment for relapsed ALL. To improve the induction remission rate, we modified the dose of idarubicin in the original Children's Cancer Group (CCG)-1884 protocol, and retrospectively compared the results. Twenty-eight patients diagnosed with relapsed ALL received induction chemotherapy according to the CCG-1884 protocol. Complete remission (CR) rate in all patients after induction chemotherapy was 57%. The idarubicin 10 mg/m2/week group showed CR rate of 74%, compared with the 22% CR rate of the idarubicin 12.5 mg/m2/week group (p=0.010). Remission failure due to treatment-related mortality (TRM) was 44% and 5.2% in the idarubicin 12.5 mg/m2/week and 10 mg/m2/week groups, respectively (p=0.011). Overall survival (OS) and 4-yr event-free survival (EFS) were 12.8% and 10.3%, respectively. OS and 4-yr EFS were higher in the idarubicin 10 mg/m2/week group (19.3% and 15.6%) than in the 12.5 mg/m2/week group (0% and 0%). In conclusion, a modified dose of idarubicin from 12.5 mg/m2/week to 10 mg/m2/week resulted in an improved CR rate in the treatment of relapsed ALL, which was due to lower TRM. However, despite improved CR rate with modified dose of idarubicin, survival rates were unsatisfactory.

Keyword

Idarubicin; Remission Induction; Recurrence; Precursor Cell Lymphoblastic Leukemia-Lymphoma

MeSH Terms

Adolescent
Antineoplastic Combined Chemotherapy Protocols/*administration & dosage
Child
Child, Preschool
Disease-Free Survival
Female
Humans
Idarubicin/*administration & dosage
Infant
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma/*drug therapy/mortality
Recurrence
Remission Induction
Retrospective Studies
Survival Rate

Figure

• 

  Fig. 1 Outcomes of treatment in all patients. Dose of weekly idarubicin changed from 12.5 mg/m2 to 10 mg/m2 in June, 1999. Ida, idarubicin; TRM, treatment-related mortality, maintenance; Tx., maintenance chemotherapy.

• 

  Fig. 2 Overall survival (OS, A) and event-free survival (EFS, B) in all patients, using Kaplan-Meier method. Estimates of OS and 4-yr EFS were 12.8% and 10.3%, respectively.

• 

  Fig. 3 Overall survivals (OS, A) and event-free survivals (EFS, B) between patients with or without complete remission (CR), using Kaplan-Meier method. Estimates of OS were 26.2% and 0% (p=0.0045), and 4-yr EFS were 18.2% and 0% (p=0.000), respectively.

• 

  Fig. 4 Overall survivals (OS, A) and event-free survivals (EFS, B) at different dose of idarubicin in induction chemotherapy, using Kaplan-Meier method. Estimates of OS were 19.3% and 0% (p=0.00001), and 4-yr EFS were 15.6% and 0% (p=0.0858), respectively.

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