Related Experiment Videos
Acute lymphoblastic leukemia in very young children. Diagnostic and therapeutic aspects of 43 cases
Insights
Intensive chemotherapy significantly improves long-term remission for infants with acute lymphoblastic leukemia (ALL). Younger children with ALL benefit from aggressive treatment, showing a higher probability of prolonged remission.
Area of Science:
- Pediatric Hematology Oncology
- Pediatric Cancer Treatment
Background:
- Acute lymphoblastic leukemia (ALL) in children under two years presents unique challenges.
- High white blood cell counts and tumor bulk are common in younger ALL patients.
Purpose of the Study:
- To evaluate the efficacy of an intensive chemotherapy regimen for acute lymphoblastic leukemia (ALL) in children under two years of age.
- To assess the impact of intensive treatment on long-term remission rates in this pediatric population.
Main Methods:
- A cohort of 43 children under two years with ALL received intensive induction chemotherapy (vincristine, daunorubicin, cyclophosphamide, prednisone, L-asparaginase) and monthly reinductions (including ArA-C).
- Central nervous system (CNS) prophylaxis involved irradiation and intrathecal methotrexate.
- Treatment protocols were adapted based on patient age and disease characteristics.
Main Results:
- Complete remission (CR) rates were 78% for patients diagnosed before 18 months and 100% for those diagnosed between 18-24 months.
- The probability of prolonged CR at 2 years was 33%, with no significant difference based on age at diagnosis.
- Children under one year receiving intensive chemotherapy showed a significantly higher probability of long CR (p < 0.02).
- Ten of 43 patients remain in CR for 27 months to 8 years; four of 18 patients under one year at diagnosis are in CR.
- No relapses occurred after 23 months, and significant sequelae were rare.
Conclusions:
- Aggressive, intensive chemotherapy is indicated for pediatric patients under two years with ALL.
- The feasibility of intensive treatment in young children is achievable with dedicated supportive care.
- Intensive chemotherapy regimens can significantly improve the prognosis for infants diagnosed with ALL.
Abstract:
Between 1974 and 1982, 43 children less than 2 years of age were treated in the hematology department of Hospital Saint-Louis for acute lymphoblastic leukemia (ALL). Of the patients who presented before 18 months of age, 80% had a WBC greater than 100,000 microliter and/or a great tumor bulk. As a result of our experience, treatment regimens have been changed here from conventional chemotherapy to a very intensive program with a heavy induction (vincristine, daunorubicin, cyclophosphamide, prednisone, and L-asparaginase) and monthly reinductions with the same drugs plus ArA-C, without maintenance. Prophylaxis included CNS irradiation (16-24 Gy) after 12 months of age, plus intrathecal methotrexate. Complete remission (CR) occurred in 78% before 18 months and in 100% between 18 and 24 months of age at diagnosis. In this report the probability of a prolonged CR (33% at 2 years) was the same before and after 12 months of age. However, younger patients were more intensively treated. The prognosis for children less than 1 year of age who received very intensive chemotherapy has greatly improved, with a significantly higher probability of long CR (p less than 0.02). Presently, 10 of 43 children are in CR 27 months to 8 years after diagnosis. Of 18 patients aged less than 1 year at diagnosis, four are in CR. No relapse occurred after 23 months. None of these patients presented with important sequellae, with the exception of one child who suffered from severe bacterial meningitis. An aggressive chemotherapy program is indicated in patients less than 2 years of age. The feasibility of this mode of treatment in young patients is possible only with the help of specific supportive care.