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Improved therapy for children with acute lymphoblastic leukemia
Insights
Treatment for childhood B-precursor acute lymphoblastic leukemia (ALL) has improved, with over 85% 4-year event-free survival (EFS) in average-risk patients. High-risk groups still face challenges, necessitating further research into prognostic factors.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Trials
Background:
- Japanese children with B-precursor acute lymphoblastic leukemia (ALL) have been treated in consecutive chemotherapeutic trials.
- Treatment results have steadily improved over time, particularly for children with average presenting features.
Purpose of the Study:
- To examine factors influencing clinical prognosis in Japanese children with B-precursor ALL.
- To assess treatment outcomes and identify prognostic indicators for improved patient management.
Main Methods:
- Analysis of data from consecutive chemotherapeutic trials conducted between 1976 and 1995.
- Evaluation of presenting features such as age and leukocyte counts to stratify patients into risk groups.
Main Results:
- The 4-year event-free survival (EFS) now exceeds 85% for children with average presenting features.
- High-dose methotrexate and intrathecal therapy replaced cranial irradiation without increasing central nervous system relapse.
- Children with unfavorable presenting features (high-risk group) have a worse prognosis, with a 4-year EFS rate better than 60%.
Conclusions:
- Significant treatment improvements have been achieved for childhood ALL in Japan.
- Further investigation into biological prognostic factors is needed to identify high-risk patients.
- For chemotherapy-resistant cases, the benefits of intensive treatments like bone marrow transplantation may outweigh risks.
Abstract:
We have examined the factors influencing clinical prognosis in Japanese children with B-precursor acute lymphoblastic leukemia (ALL), who have been treated in consecutive chemotherapeutic trials from 1976 to 1995. During this time the results of treatment have steadily improved in children with average presenting features (age 1-10 years old and leukocyte counts > 50,000/microL). The 4-year event-free survival (EFS) estimates now exceed 85% in our current trials. Furthermore, high-dose methotrexate and intrathecal therapy could be substituted for cranial irradiation without an increase of central nervous system relapse rate. However, children with unfavorable presenting features (leukocyte counts > or = 50,000/microL; high-risk group) have a worse prognosis, although there is some improvement of outcome. The patients in the high-risk group have obtained the 4-year EFS rate of better than 60%. Further investigations of prognostic factors in ALL focused on the biological features may permit identification of groups of children at risk of very poor outcome. In the patient cohorts consistently resistant to chemotherapy, the hazards of more intensive treatment such as bone marrow transplantation may be outweighed by the possible benefits.