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Acute lymphoblastic leukemia in infants
Aytemiz Gürgey1, Sevgi Yetgin, Mualla Cetin
1Section of Hematology, Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Insights
Treatment for infant acute lymphoblastic leukemia (ALL) improved significantly over time. Newer protocols (Total Therapy XI and XIII) demonstrated better event-free survival rates compared to earlier regimens.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Trials
Background:
- Infant acute lymphoblastic leukemia (ALL) historically has a poor prognosis.
- Treatment advancements are crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To evaluate the efficacy of sequential treatment protocols for newly diagnosed infants with ALL.
- To compare event-free survival rates between different treatment eras.
Main Methods:
- Retrospective analysis of 29 infants with ALL treated between 1978 and 1999.
- Group 1 (1978-1991): Two- or three-drug induction with prednisolone, vincristine, L-asparaginase, and 3-year maintenance (mercaptopurine, methotrexate).
- Group 2 (1991-1999): St. Jude Total Therapy XI and XIII protocols with modifications.
Main Results:
- Three-year event-free survival was 14% in Group 1.
- Event-free survival in Group 2 was 25% (Total XI) and 57% (Total XIII).
- Outcomes significantly improved with Total Therapy XI and XIII protocols compared to Group 1.
Conclusions:
- Sequential treatment protocols have progressively improved outcomes for infants with ALL.
- The St. Jude Total Therapy XI and XIII protocols represent significant advancements in infant ALL treatment.
- Further research into optimized therapies for infant ALL is warranted.
Abstract:
Between January 1978 and August 1999, 29 infants with newly diagnosed acute lymphoblastic leukemia (ALL) were treated on three consecutive protocols. Eighteen patients with infant ALL diagnosed between 1978-1991 were included in Group 1. In this group, treatment comprised a two- or three-drug induction with prednisolone, vincristine and L-asparaginase, and maintenance therapy consisted of weekly oral administration of mercaptopurine and methotrexate for three years. Group 2: Between 1991 and 1999, 11 infants with ALL were treated by St. Jude Total Therapy XI (n=4) and XIII (n=7) protocols with minor modification. Three years' event-free survival (+/-SE) was 14 +/- 9% in group 1. In group 2, this rate was 25 +/- 22% in Total XI and 57 +/- 19% in Total XIII. Outcome for infants on protocols Total Therapy XI and XIII improved compared with that of group 1.
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