[Recent advances on the treatment of acute childhood leukemia]

Since 1981, the Children's Cancer and Leukemia Study Group (CCLSG) has developed a series of protocols for treatment of acute childhood leukemia in children. Life-table analysis of serial CCLSG protocols for acute lymphoblastic leukemia (ALL) revealed that the outcome of overall All has gradually improved with a increase of the event free survival (EFS) rates; 41.4 +/- 3.6% at 14 years for the 811 protocol, 51.3 +/- 3.5% at 11 years for the 841 protocol, 56.7 +/- 3.1% at 8 year for the 874 protocol, and 78.2 +/- 3.1% at 5 year for the 911 protocol. Treatment outcome and prognostic factors were evaluated in 152 children with acute myeloblastic leukemia (AML) treated on three consecutive protocols (ANLL-861, 8912 and 9205) of CCLSG. Forty-two of these 46 patients (91.3%) in the ANLL-9205 protocol achieved complete remission and 58.8% of these patients projected a 3-year disease free survival. These results were apparently superior to those obtained with the ANLL-861 and 8912 protocols, which used conventional doses of multiple drugs followed by a moderate post remission chemotherapy of long duration. This favorable response with the ANLL-9205 protocol was mainly to high induction rate of patients with the M4 and M5 subtypes, as compared to those in the previous two protocols. An older age (> or = 8 years) and high WBC count (> or = 10 x 10(9)/l) predicted an increased risk of relapse in multivariate analyses; patients with an age > 8 years and WBC counts > or = 10 x 10(9)/l had a 4.5 times higher risk of relapse than patients without these adverse features.