[Long-term results of multiple sequential treatment (protocol HIM-T.S.M) of children with acute lymphoblastic...

The long-term results of treatment of 32 children with acute lymphocytic leukemia, treated with protocol HIM-TSM, are reported. Induction therapy with prednisone and vincristine, gave 94% of complete remissions. Only 25 patients were evaluable for the maintenance therapy study. They reveived two courses of cyclic intensive chemotherapy with seven drugs (methotrexate, 6-mercaptopurine, cyclophosphamide, prednisone, vincristine, intrathecal methotrexate and hydrocortine, daunomycin and citosine-arabinoside) at high doses and thereafter, cyclic MTX 6MP and CP and periodic VCR and Pred. Median duration of complete remission was 28 months and 40% of the patients had initial relapse in central nervous system (median time of presentation of CNS relapse was 25 months). On Feb., 1976, 56% of the children are alive but 24% of them have had at least one relapse and now, are again in remission. Eight cases (32%) have never relapsed, from 42 to 58 months after remission was obtained (median of 46 months) and they are now off any antileukemic therapy for 11 to 22 months (median of 16 months). These long-term results are compared with those obtained with a previously reported protocol (HIM-TMI). No significant progresses were seen in the Protocol HIM-TSM, but both studies showed very good results for this country. More intensive systemic chemotherapy and CNS prophylaxis are needed. This has been taken into account in a more recent study (Protocol HIM-06) and the preliminary results are encouraging. Fourteen patients from these studies and several other children, all of them with more than 42 months of continuous remission and off therapy, have in our experience, a high chance of being cured.