Prognostic significance of testicular relapse in boys with acute lymphoblastic leukemia

Among 107 boys with acute lymphoblastic leukemia who achieved initial complete remission after treatment according to two therapeutic protocols for standard and high risk leukemias, respectively, in 14 (13%) testicular leukemia was observed. Isolated testicular involvement was noted in 4, and combined with medullary relapse in 10 patients. The prognosis was worse in children with high risk leukemias (mainly in those with more than 20 x 10(9)/l white blood cells and/or with less than 50 x 10(9)/l platelets). Prognosis depended also on the type of relapse. It was better in isolated as well as in late testicular relapse. It was worse in combined relapses as well as in early testicular involvement. Bilateral wedge biopsy of the testes was performed in 16 boys at the end of chemotherapy and leukemic infiltration was shown in none of them. Two to 13 months thereafter, in four boys testicular relapse developed, and in 2 boys bone marrow relapse followed 9 and 13 months later. Wedge biopsy of the testes in boys with leukemia does not seem to be of importance neither for diagnosis of testicular relapse nor for improving prognosis.