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[Outcome of childhood high-risk acute lymphoblastic leukemia treated with the ALL-BFM 95 protocol]
Yong-Sheng Ruan1, Xue-Dong Wu, Xiao-Qin Feng
1Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. fxq126126@126.com.
Insights
The Acute Lymphoblastic Leukemia Berlin-Frankfurt-Münster 95 (ALL-BFM 95) protocol shows promise for treating high-risk acute lymphoblastic leukemia (HR-ALL) in children. Relapse remains a significant concern, but combining chemotherapy with hematopoietic stem cell transplantation (HSCT) improves survival outcomes.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Trials
Context:
- Childhood high-risk acute lymphoblastic leukemia (HR-ALL) presents a significant therapeutic challenge.
- The Acute Lymphoblastic Leukemia Berlin-Frankfurt-Münster 95 (ALL-BFM 95) protocol is a treatment regimen for pediatric ALL.
- Evaluating established protocols is crucial for optimizing treatment strategies.
Purpose:
- To assess the effectiveness and practicality of the ALL-BFM 95 protocol in pediatric HR-ALL.
- To analyze survival rates and identify factors influencing outcomes in children treated with this protocol.
Summary:
- A retrospective analysis of 47 children with HR-ALL treated under the ALL-BFM 95 protocol was conducted.
- The 5-year event-free survival was 62%, with relapse being the primary cause of death.
- Hematopoietic stem cell transplantation (HSCT) post-chemotherapy significantly improved event-free survival compared to chemotherapy alone (77% vs. 52%, P=0.035).
Impact:
- The ALL-BFM 95 protocol demonstrates potential for improving outcomes in pediatric HR-ALL.
- Identifying poor responders to prednisone and specific bone marrow subgroups (Days 15 and 33 M3) aids in risk stratification.
- The findings support the integration of HSCT for high-risk pediatric ALL patients to enhance survival.
Objective:
To evaluate the effectiveness and the practicability of the Acute Lymphoblastic Leukemia Berlin-Frankfurt-Münster 95 (ALL-BFM 95) protocol in treating childhood high-risk acute lymphoblastic leukemia (HR-ALL).
Methods:
A retrospective analysis of 47 children with newly diagnosed HR-ALL between July 2003 and August 2013 was performed. These children were treated by the ALL-BFM 95 protocol. Survival was evaluated by Kaplan Meier analysis and Log-Rank test.
Results:
Relapse-related death occurred in 12 of 47 patients (26%), and 5 of 47 patients (11%) were treatment-related mortality. Five-year probability of event-free-survival (pEFS) was 62%. Children with hematopoietic stem cell transplantation (HSCT) after chemotherapy achieved significantly better pEFS than those with chemotherapy alone (77% vs 52%; P=0.035). The patients who were only poor responders to prednisone had a better outcome (5-year pEFS 80%) than the Days 15 and 33 bone marrow M3 subgroups (5-year pEFS 60% and 0 respectively).
Conclusions:
ALL-BFM 95 protocol can improve the outcome of children with high-risk ALL. The major cause of death is attributed to relapse. Chemotherapy plus HSCT can produce a better outcome than chemotherapy alone. The Days 15 and 33 bone marrow M3 subgroups have a poor prognosis.
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