Bone marrow relapse occurring as first relapse in children with acute lymphoblastic leukemia
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H Behrendt1, E F van Leeuwen, C Schuwirth
1Werkgroep Kindertumoren, Emma Kinderziekenhuis, Amsterdam, The Netherlands.
Insights
Intensifying treatment for childhood acute lymphoblastic leukemia (ALL) relapse is crucial. Children relapsing after initial treatment have a better prognosis, highlighting the need for more aggressive relapse therapies.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Relapse remains a significant challenge in pediatric ALL treatment.
- Understanding prognosis factors for isolated bone marrow relapse is vital.
Purpose of the Study:
- To evaluate the prognosis of children with isolated bone marrow relapse of ALL.
- To identify factors influencing survival after first bone marrow relapse.
- To assess the effectiveness of past relapse treatment strategies.
Main Methods:
- Retrospective review of 164 children with isolated bone marrow relapse of ALL.
- Data collected from the Dutch childhood population (1973-1983).
- Analysis of initial treatment, relapse timing, and survival outcomes.
Main Results:
- 78% of patients achieved a second complete remission (CR).
- Median duration of second CR was 9 months; median survival was 13 months.
- Relapse within 24 months of diagnosis was universally fatal; relapse after initial treatment cessation showed better outcomes.
Conclusions:
- Duration of first CR is a key prognostic factor.
- Current relapse treatment strategies were heterogeneous and not intensive.
- Treatment intensification for first bone marrow relapse in children is recommended.
Abstract:
In a retrospective review which covered the whole Dutch childhood population of approximately 3 million children we studied the prognosis in 164 children with acute lymphoblastic leukemia (ALL) who were initially treated between 1973 and 1983, and who had an isolated bone marrow relapse occurring as first relapse. Until their first relapse, the patients were initially treated according to standard protocols, while treatment for relapse was heterogeneous, and not intensive. Second complete remission (CR) was attained by 78% of the patients. The median duration of second CR was 9 months, the median survival 13 months. Multivariate analysis showed that the duration of the first CR was the most significant variable with regard to prognosis. None of the patients who developed their bone marrow relapse during initial treatment, i.e., within 24 months from diagnosis, survived. Among the 73 patients who relapsed after cessation of the initial treatment there were 19 long-term disease-free survivors, 14 of whom had not developed subsequent relapses after 48(+)-125 + months. From this study we conclude that treatment in children with first bone marrow relapse has to be intensified.