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Second induction in pediatric patients with recurrent acute lymphoid leukemia using DFCI-ALL protocols
Jean-Hugues Dalle1, Albert Moghrabi, Pierre Rousseau
1Division of Hematology-Oncology, Hôpital Sainte Justine, Montréal, Quebec, Canada.
Journal of Pediatric Hematology/Oncology
|February 11, 2005
Summary
Children with relapsed acute lymphoblastic leukemia (ALL) can achieve a second remission using the DFCI ALL protocol. While effective, long-term survival for these pediatric ALL patients remains a challenge.
Area of Science:
- Pediatric Oncology
- Hematology
- Leukemia Research
Background:
- Acute lymphoblastic leukemia (ALL) recurrence affects 15-30% of pediatric patients.
- Second complete remission (CR) is crucial for subsequent allogeneic hematopoietic stem cell transplantation (HSCT).
Purpose of the Study:
- To evaluate the institutional experience in managing pediatric recurrent ALL.
- To assess the efficacy and safety of re-induction chemotherapy using the DFCI ALL protocol in patients previously treated with it.
Main Methods:
- Retrospective analysis of 34 pediatric patients with recurrent ALL treated with the DFCI ALL protocol.
- Patients initially diagnosed and treated with the DFCI ALL protocol received the same regimen for re-induction.
- Subsequent allogeneic HSCT was performed when feasible.
Main Results:
- Second CR was achieved in 85% (29/34) of patients.
- Twenty patients proceeded to allogeneic HSCT, with 10 currently in CR.
- Overall survival was 38% (13/34) at a median follow-up of 105 months.
- No toxic deaths occurred during re-induction therapy.
Conclusions:
- Re-induction chemotherapy with the DFCI ALL protocol in children with recurrent ALL yields a high rate of second CR without increased toxicity.
- Despite high re-induction rates, the overall prognosis for these patients remains poor, necessitating improved therapeutic strategies.