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Discontinuing therapy in childhood acute lymphoblastic leukemia treated with a chemoimmunotherapy protocol
Y Komada1, E Azuma, H Yamamoto
1Department of Pediatrics, Mie University School of Medicine, Japan.
Insights
Discontinuing chemotherapy in Japanese children with acute lymphoblastic leukemia (ALL) led to relapses in 11.7% of patients, particularly boys. Immunotherapy cessation showed no relapses, suggesting potential benefits for preventing bone marrow recurrence.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Treatment protocols involve chemotherapy and immunotherapy.
- Understanding the long-term outcomes after treatment cessation is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the outcomes of discontinuing chemotherapy and immunotherapy in Japanese children with ALL.
- To identify risk factors for relapse after treatment cessation.
- To assess the role of immunotherapy in preventing relapses.
Main Methods:
- Analysis of data from 209 Japanese children with ALL.
- Tracking patients who stopped chemotherapy after 3 years of remission.
- Tracking patients who stopped immunotherapy after 5 years of remission.
Main Results:
- 11.7% of children (14/120) relapsed after stopping chemotherapy, with a higher rate in boys.
- Relapses predominantly occurred at extramedullary sites, including the central nervous system and bone marrow.
- No relapses were observed in the 72 children who discontinued immunotherapy.
Conclusions:
- Long-term remission and potential cure are achievable for approximately half of newly diagnosed Japanese ALL patients.
- While immunotherapy did not improve overall outcomes, it may help prevent bone marrow relapses post-chemotherapy.
- Gender is a significant factor in post-chemotherapy relapse rates.
Abstract:
We examined the results of discontinuing therapy in Japanese children with acute lymphoblastic leukemia. Of the 209 patients in the chemoimmunotherapy study, 120 (57.4%) had all chemotherapy stopped after 3 years of complete remission, and 72 (34.4%) reached the point of discontinuing immunotherapy after 5 years of complete remission. Of the 120 children removed from chemotherapy, 14 (11.7%) have relapsed, mainly in the extramedullary sites (5: testis, 5: bone marrow, 3: central nervous system, 1: bone); relapses occurred 1-23 months after cessation of chemotherapy (median 11 months). Boys had higher post-chemotherapy relapse rate than girls (0.21 versus 0.08, P less than 0.05). None of the 72 children removed from immunotherapy have yet relapsed. Long-term remission and possibly cure can be expected in approximately one-half of newly diagnosed Japanese patients. Although the active immunotherapy had no beneficial effect on the overall outcome for leukemic children, it could be of benefit to the elimination of bone marrow relapses after cessation of chemotherapy.