Treatment of testicular relapse in childhood acute lymphoblastic leukemia

The experience of rescue therapy for 6 patients of childhood acute lymphoblastic leukemia (ALL) with testicular relapse is reported. In two patients, testicular relapse occurred 1 and 4 years off therapy, respectively. Two patients had testicular relapse on therapy. The remaining 2 patients had testicular relapse after premature discontinuation of therapy by the parents. Isolated testicular relapse was found in 2 patients. The rest of the testicular relapses were concurrent with either bone marrow (BM) or central nervous system (CNS) relapses. The rescue therapy included bilateral testicular irradiation 24 Gy, and systemic reinduction chemotherapy, followed by maintenance therapy as that of TCL 821 or TCL 842 protocol for high risk patients of ALL. CNS prophylaxis, which included intrathecal medication and/or cranial irradiation 18 Gy (if not given before), was also given. After testicular relapse, one had subsequent BM and CNS relapses and received more aggressive chemotherapy. Another one had subsequent CNS relapse 4 months after another premature withdrawal of treatment. One patient, who presented with CNS leukemia at diagnosis, had concurrent testicular and CNS relapses and died of CNS leukemia 3 months later. The remaining 5 patients remained in continuous complete remission for 26 to 95 months with a median duration of 54 months.