Modified BFM protocol for childhood acute lymphoblastic leukemia: a retrospective analysis

Area of Science:

• Pediatric Oncology
• Hematology

Background:

• Childhood acute lymphoblastic leukemia (ALL) survival rates exceed 70% in developed countries.
• Developing nations face challenges in achieving similar survival rates due to inadequate supportive care.
• The standard Berlin-Frankfurt-Munich (BFM) protocol requires adaptation for resource-limited settings.

Purpose of the Study:

• To evaluate a modified BFM protocol for pediatric ALL, aiming to reduce toxicity while maintaining favorable response rates.
• To assess the feasibility and effectiveness of dose-reduced asparaginase and methotrexate in the consolidation and reinduction phases.
• To identify prognostic factors influencing disease-free survival (DFS) in pediatric ALL patients treated with the modified protocol.

Main Methods:

• A modified BFM protocol with reduced doses of asparaginase and methotrexate was administered to 42 pediatric ALL patients (age < 15).
• Treatment was conducted between November 1990 and November 1993.
• Prognostic factors for DFS were analyzed using univariate and multivariate methods, including central nervous system (CNS) involvement and time to complete remission (CR).

Main Results:

• All 42 patients achieved complete remission (CR).
• The 48-month overall survival (OS) probability was 59.4%, and DFS probability was 52.5%.
• Multivariate analysis identified CNS disease as the sole significant poor prognostic variable for prolonged DFS (P < 0.0083).

Conclusions:

• The modified BFM protocol demonstrates potential for improving pediatric ALL outcomes in settings with limited resources.
• Central nervous system involvement is a critical factor impacting long-term disease-free survival in pediatric ALL.
• Further research and implementation of adapted protocols are crucial for enhancing childhood ALL survival globally.