[Multiple agent cyclic chemotherapy in the treatment of acute lymphoblastic leukemia of children ("C"-protocol)...

61 consecutive children having A.L.L., were treated, between 1970 and 1974, according to a chemotherapy protocol including: 1. Induction treatment with prednisolone, vincristine and daunorubicine. 2. Maintenance therapy using three types of two drugs combinations, administered by cycles of three months duration each one. The associations were: mercaptopurine-methotrexate, mercaptopurine-cytosine arabinoside and methotrexate-cyclophosphamide. Between cycles, "reinductions" with prednisolone and vincristine of two weeks duration were given. 3. "Prophylactic" treatment of CNS leukemia was administered according to two modalities: a) In group named C-1, 32 patients received one dose of i.t. methotrexate at the end of the induction treatment and every three months. b) The other 29 patients (C-2 group) were treated by cranial irradiation (2400 r.) and five doses of i.t. methotrexate, after the induction of remission (C.R.).

57 out of 61 patients (93%) attained C.R. Twelve months after induction of C.R., in C-1 group, one patient died by infectious disease and eight relapsed. Twenty (68%) remained in C.R. The number of CNS relapses in this period was six (20%). In C-2 group, from 21 evaluable cases, 18 children (85%) were in C.R. at the end of first year and relapses in CNS were only two (9%). The median duration of remission in the first group was about three years. Percentage of cases with CNS relapses in three years was 35%. At the end of 4 th. year 37% remained in the initial C.R.-80% of the evaluable patients receiving cranial irradiation persisted in remission at the end of the second year. Efficacity of the prophylactic treatment of CNS infiltration, by cranial irradiation and i.t. chemotherapy is confirmed. Cyclic use of several combinations of drugs don't appear to be superior to the use of one single association (MP-MTX), but other combinations used here may be taken in account in cases of severe intolerance to one of these drugs.