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Treatment of children with acute lymphoblastic leukemia in India using a BFM protocol
Ashish Bajel1, Biju George, Vikram Mathews
1Department of Haematology, Christian Medical College, Vellore, Tamil Nadu 632004, India.
Insights
Long-term outcomes for childhood acute lymphoblastic leukemia (ALL) in India are presented. The study highlights survival rates and identifies key prognostic factors, emphasizing the need for cost-effective treatment improvements.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Limited data on long-term treatment outcomes for childhood acute lymphoblastic leukemia (ALL) in India.
- Need for understanding prognosis in Indian pediatric ALL patients.
Purpose of the Study:
- Evaluate treatment outcomes and prognostic factors in Indian children with ALL.
- Assess the effectiveness of a modified BFM protocol for childhood ALL.
Main Methods:
- Treatment of 307 children (1-14 years) with ALL using a modified BFM protocol (1985-2003).
- Analysis of treatment outcomes, including remission rates, survival, and event-free survival.
- Identification of prognostic factors influencing treatment success.
Main Results:
- 91.6% achieved complete remission; 56.8% of complete responders maintained continuous complete remission (CCR) at median 62 months follow-up.
- Estimated 5-year overall survival was 59.8%, with event-free survival (EFS) at 56%.
- Poor prednisolone response, resistant disease, and high WBC count (>20 x 10(9)/L) were adverse prognostic factors.
Conclusions:
- The modified BFM protocol demonstrated achievable outcomes in Indian children with ALL.
- Identified prognostic factors can guide risk stratification and treatment intensification.
- Cost-effective improvements are necessary to enhance long-term survival for childhood ALL in India.
Background:
Limited data exists on the long-term treatment outcome and prognosis of childhood ALL in India.
Procedure:
Three hundred and seven children (1-14 years) with acute lymphoblastic leukemia (ALL) were treated with a modified BFM protocol 76/79 between 1985 and 2003. Treatment outcome and prognostic factors were evaluated.
Results:
The median age was 6 years; 78% had B lineage acute lymphoblastic leukemia and 22% had T lineage disease. Good prednisolone response was observed in 82% of cases. Two hundred and seventy-three children (91.6%) achieved complete remission; with 2% induction-related mortality and 6.4% having resistant disease. 52% of all evaluable patients and 56.8% of complete responders are in continuous complete remission (CCR) at a median follow up of 62 months (30-194 months). The median event free survival (EFS) was 114 months. The estimated 5 year overall survival, EFS and disease free survival was 59.8%, 56%, and 53.9%, respectively. The prognostic factors adversely affecting the EFS were poor prednisolone response, resistant disease and WBC count greater than 20 x 10(9)/L at diagnosis. The 5 year EFS in the favorable risk group (age 1-9 years, WBC count less than 20 x 10(9)/L and prednisolone good response) was 73.1 +/- 4.9%.
Conclusion:
This report examines a cohort of children with ALL treated with a BFM protocol in India with adequate follow up and demonstrates the need for cost effective improvements.
