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Childhood acute lymphoblastic leukemia: results of the Austrian Cooperative Study Group with the ALL A 84 protocol
E R Gruemayer1, H Gadner, I Mutz
1St. Anna Children's Hospital, Vienna, Austria.
Insights
This study on childhood acute lymphoblastic leukemia (ALL) found that risk-adapted treatment achieved high remission rates (97.6%). Event-free survival was 72%, with standard-risk patients showing better outcomes than medium-risk patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Trials
Background:
- Childhood acute lymphoblastic leukemia (ALL) requires tailored treatment strategies.
- Risk stratification is crucial for optimizing therapeutic outcomes in pediatric ALL.
Purpose of the Study:
- To evaluate the efficacy and safety of a risk-adapted treatment regimen for childhood ALL.
- To assess event-free survival (EFS) based on risk stratification.
Main Methods:
- Prospective treatment of 127 children with ALL using a risk-adapted regimen.
- Standard induction-consolidation therapy for all patients.
- Risk-specific maintenance and intensification phases, including methotrexate, ARA-C, and L-asparaginase.
- Prophylactic cranial irradiation tailored to risk groups.
Main Results:
- Complete remission achieved in 97.6% of patients.
- Overall probability of event-free survival (pEFS) was 72% at 42 months median follow-up.
- Standard-risk patients had a higher pEFS (76%) compared to medium-risk patients (63%) at 42 months.
- Relapse within 18 months indicated poor prognosis, more frequent in medium-risk patients.
- Initial high white blood cell count (>50 X 10(9)/l) was associated with a worse prognosis.
Conclusions:
- Risk-adapted therapy is effective in achieving high remission rates in childhood ALL.
- Treatment stratification improves outcomes, though differences between risk groups may attenuate over time.
- Initial white blood cell count is a significant prognostic factor in risk-adapted ALL treatment.
Abstract:
We prospectively treated 127 children with ALL with a risk-adapted regimen. All patients received the identical induction-consolidation therapy. The early maintenance included intermediate dose methotrexate in patients with standard risk (n = 79) and medium risk (n = 39). In addition patients with high risk (n = 6) received high dose ARA-C followed by L-asparaginase. Intensification treatment and prophylactic cranial irradiation was also tailored according to the risk group. Treatment duration was 2 years. Complete remission was achieved in 97.6% of all patients. Treatment-related toxicity accounted for one death in complete remission. The probability of event-free survival (pEFS) for the combined group was 72% at a median follow-up of 42 months. The pEFS was higher in patients with standard risk (SR) than in patients with medium risk (MR) (80% versus 65%; p less than 0.05) at 30 months, but attenuated in the follow-up evaluation at 42 months (76% versus 63%; p less than 0.1). The number of high-risk patients was too small for statistical evaluation. Relapse within the first 18 months after diagnosis indicated a poor prognosis and was more common in patients with MR than in patients with SR. The immunophenotype of the leukemic cells was not found to constitute an independent risk factor after treatment has been risk-adapted. Patients with an initial white blood cell count of more than 50 X 10(9)/l had a worse prognosis than patients with a lower white blood cell count (p less than 0.01).