Long-Term Outcome of Treatment With Protocols AL841, AL851, and ALHR88 in Children With Acute Lymphoblastic Leukemia: Results Obtained by the Kyushu-Yamaguchi Children’s Cancer Study Group
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We analyzed the long-term outcome and late effects of treatment in 187 patients with childhood acute lymphoblastic leukemia (ALL) diagnosed between 1984 and 1990. Overall survival and event-free survival rates were 68.2% +- 3.7% and 63.2% +- 3.6% at 15 years, respectively. Of 55 patients who relapsed after achieving the first complete remission (CR), only 17.4% were rescued by salvage therapy. The advantage of stem cell transplantation over chemotherapy was observed only in those patients with bone marrow relapse during therapy. The SD for score height in patients maintaining the first CR significantly decreased at the time of final follow-up compared with that at diagnosis: 0.059 to -0.800 (P < .0001). The decrease was remarkable in patients younger than 5 years at diagnosis. Other late effects included mild liver dysfunction in 18% and hepatitis C virus infection in 9%. Congestive heart failure was observed in only 2.9% of patients despite the high cumulative dose of daunorubicin (450 mg/m2). Although the survival rates of patients on our protocols were comparable to those of other study groups, some modification, including reduction in dose of cranial irradiation and/or anticancer drugs, should be considered to reduce late adverse effects in survivors of childhood ALL.
Key wordsAcute lymphoblastic leukemia Child Chemotherapy Growth impairment Late effect
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- 1.Pui AH, Crist WM. Acute lymphoblastic leukemia. In: Pui CH, ed.Childhood Leukemia. Cambridge, Ma: Cambridge University Press; 1999:288–312.Google Scholar
- 2.Blatt J, Copeland DR, Bleyer WA. Late effects of childhood cancer and its treatment. In: Pizzo PA, Poplack DG, eds.Principle and Practice of Pediatric Oncology. Philadelphia, Pa: Lippincott-Raven Publishers; 1997:1303–1329.Google Scholar
- 3.Hudson M. Late complications after leukemia therapy. In: Pui CH, ed.Childhood Leukemia. Cambridge, Ma: Cambridge University Press; 1999:463–481.Google Scholar
- 7.Conter V, Arico M, Valsecchi MG, et al. Extended intrathecal methotrexate may replace cranial irradiation for prevention of CNS relapse in children with intermediate-risk acute lymphoblastic leukemia treated with Berlin-Frankfurt-Munster-based intensive chemotherapy.J Clin Oncol. 1995;13:2497–2502.CrossRefPubMedGoogle Scholar
- 11.Tubergen DG, Gilchrist GS, O’Brien RT, et al. Prevention of CNS disease in intermediate-risk acute lymphoblastic leukemia: comparison of cranial irradiation and intrathecal methotrexate and the importance of systemic therapy: a Children’s Cancer Group report.J Clin Oncol. 1993;11:520–526.CrossRefPubMedGoogle Scholar
- 17.von der Weid N, Wagner B, Angst R, et al. Treatment of relapsing acute lymphoblastic leukemia in childhood. III. Experience with 54 first bone marrow, nine isolated testicular and eight isolated central nervous system relapses observed 1985-1989.Med Pediatr Oncol. 1994;22:361–369.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Ishii E, Miyazaki S, Kai T, Matsuzaki A, Akazawa K, Ueda K. Growth impairment in children with leukemia/lymphoma and solid tumors administered chemotherapy.Int J Pediatr Hematol Oncol. 1995;2:351–356.Google Scholar
- 32.Morris MJ.In Vitro Effects of Antileukemia Drugs on Cartilage Metabolism and Their Effects on Somatomedin Production by Liver. Manchester, UK: Manchester University; 1981 [Thesis].Google Scholar