OUTCOME OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKAEMIA AFTER INDUCTION THERAPY—3 YEARS EXPERIENCE AT A SINGLE PAEDIATRIC ONCOLOGY CENTRE

Authors

  • Zulfiqar Ali Rana
  • Muhammad Waqar Rabbani
  • Muhammad Aslam Sheikh
  • Afsheen Asghar Khan

Abstract

Background: Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy. Itrepresents 25% of all childhood cancers and approximately 75% of all cases of childhood leukaemia.A sharp peak of ALL incidence is observed at 2–5 years of age. Objective was to see the bonemarrow remission pattern at the end of induction therapy in paediatric ALL patients in our setup. Itwas a Descriptive case series and conducted at Paediatric Oncology Department, Children Hospitalcomplex Multan from December, 2005 to December, 2008. Methods: Thirty-eight paediatric ALLpatients were included in the study. Diagnosis was based on history, examination, blast cells counton peripheral blood film and bone marrow biopsy and immunophenotyping on peripheral blood/bonemarrow aspirate. According to UK ALL 2003 protocol all patients were given 4-drug inductiontherapy, i.e., vincristine, prednisolone/dexamethasone, L-aspiragenase and daunomycin. Bonemarrow biopsy was repeated at day 28 of induction therapy and remission pattern was seen. Results:Out of 38 Patients, 26 (68%) were males. Age range was between 2–12 years (Mean 5.4 years).Bone Marrow Biopsy was done in 38 (100%) and Immunophenotyping in 34 (89%) patients. At day28 of induction therapy, 28 (74%) patients went into complete remission (<5% blast cells in bonemarrow), 2 (5%) into partial remission (5–25% blast cells in bone marrow) and 1 (3%) was not inremission (>25% blast cells in the bone marrow). Seven (18%) patient died due to febrileneutropenia and sepsis during the course of induction therapy. Conclusion: ALL in children iscurable with effective chemotherapy. Remission can be achieved in most of these patients afterinduction therapy. However outcome can be improved with effective control of infections.Keywords: Acute Lymphoblastic Leukaemia, Induction Therapy, Remission.

References

Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer

Statistics, 2000. CA Cancer J Clin 2000;50:7–33.

McNally RJ, Rowland D, Roman E, Cartwright RA. Age and

Sex distribution of Hematological Malignancies in the U.K.

Hematol Oncol 1997;15:173–89.

Shah A, Coleman MP. Increasing Inciudence of Childhood

Leukemia: a controversy Re-examined. Br J Cancer

;97:1009–12.

Pui CH, Relling MV, Downing JR. Acute Lymphoblastic

Leukemia. N Engl J Med 2004;350:1535–48.

Schrappe M. Evolution of BFM Trials of Childhood ALL. Ann

Hematol 2004;83(Suppl 1):121–3.

Chessells JM. Recent advances in the Management of Acute

Leukemia. Arch Dis Child 2000;82:438–42.

Saarinen-Pihkala UM, Gustafsson G, Carlsen N, Flaegstad

T, Forestier E, Glomstein A, et al. Outcome of Children with

High risk acute lymphoblastic leukemia (HR-ALL): Nordic

J Ayub Med Coll Abbottabad 2009;21(4)

http://www.ayubmed.edu.pk/JAMC/PAST/21-4/Zulfiqar.pdf 153

results on an intensive regimen with restricted central nervous

system irradiation. Pediatr Blood Cancer 2004;42:8–23.

Margolin JF, Steuber CP, Poplack DG. Acute lymphoblastic

leukemia. In: Pizzo PA, Poplack DG, (eds). Principles and

Practice of Pediatric Oncology. 4th ed. Philadelphia: Lippincott

Williams & Wilkins;2002:p. 489–544.

Pui CH, Evans WE. Treatment of acute lymphoblastic

leukemia. N Eng J Med 2006;354:166–78.

Ortega JA, Nesbit ME Jr, Donaldson MH, Hittle RE, Weiner

J, Karon M, et al. L-Asparaginase, vincristine and prednisone

for induction of first remission in acute lymphocytic leukemia.

Cancer Res 1977;37:535–40.

Reiter A, Schrappe M, Ludwig WD, Hiddemann W, Sauter

S, Henze G, et al. Chemotherapy in 998 unselected childhood

acute lymphoblastic leukemia patients. Results and conclusions

of the multicenter trial ALL-BFM 86. Blood 1994;84:3122–3.

Gaynon PS, Bleyer WA, Steinherz PG, Finklestein JZ, Littman

PS, Miller DR, et al. Modified BFM therapy for children with

previously untreated acute lymphoblastic leukemia and

unfavorable prognostic features. Report of Children’s Cancer

Study Group Study CCG-193P. Am J Pediatr Hematol Oncol

;10:42–50.

Gaynon PS, Desai AA Bostrom BC Hutchinson RJ, Lange BJ,

Nachman JB, et al. Early response to therapy and outcome in

Childhood acute lymphoblastic leukemia. A review. Cancer

;80:1717–26.

Lilleyman JS. Clinical Importance of Speed of response to

therapy in childhood Lymphoblastic leukemia. Leuk.

Lymphoma 1998;31:501–6.

Gajjar A, Ribeiro R, Hancock ML, Rivera GK, Mahmoud

H, Sandlund JT, et al. Persistence of circulating blasts after 1

week of multiagent chemotherapy confers a poor prognosis in

childhood acute lymphoblastic leukemia. Blood.

;86:1292–5.

Schrappe M, Reiter A, Ludwig WD, Harbott J, Zimmermann

M, Hiddemann W, et al. Improved outcome of childhood

acute lymphoblastic leukemia despite reduced use of

anthracyclines and cranial radiotherapy. Results of trial ALLBFM 90. German-Austrian-Swiss ALL-BFM Study Group.

Blood 2000;95:3310–22.

Balduzzi A, Valsecchi MG, Uderzo C, De Lorenzo

P, Klingebiel T, Peters C, et al. Chemotherapy versus allogenic

transplantation for very high risk childhood acute

lymphoblastic leukemia in first complete remission.

Comparison by genetic randomization in an international

Prospective Study. Lancet 2005;366:635–42.

Silverman LB, Gelber RD, Young ML, Dalton VK, Barr RD,

Sallan SE, Induction failure in acute lymphoblastic leukemia in

childhood. Cancer 1999;85:1395–404.

Pui CH. Childhood Leukemias. N Engl J Med 1995;332:1618–30.

Gaynon PS, Steinherz PG, Bleyer WA, Albin AR, Albo VC,

Finklestein JZ, et al. Improved therapy for children with acute

lymphoblastic leukemia and unfavorable presenting features: a

follow-up report of the children cancer group study CCG-106.

J Clin Oncol 1993;11:2234–42.

Schrappe M, Zimmermann M, Moricke A. Dexamethasone in

induction can eliminate one third of all relapses in childhood

acute lymphoblastic leukemia (ALL): Results of an

international sandomized trial in 3655 patients (Trial AIEOPBFM ALL 2000) Blood 2008;112:9, Abstract Number 7.

Bestrand Y, Suciu S, Benoit Y, Robert A, Nelken B,

Uyttebroeck A, et al. Dexamethasone (DEX) (6mg/sm/d) and

prednisolone (PRED) (60 mg/sm/d) in induction therapy of

childhood ALL are equally effective. Results of the 2nd interim

analysis of EORTC Trial 5895.(Abstract) Blood 2008;112:8.

Hurwitz CA, Silverman LB, Schorin MA, Clavell LA, Dalton

VK, Glick KM, et al. Substituting dexamethasone for

prednisolone complicates remission induction in children with

acute lymphoblastic leukemia. Cancer 2000;88:1964–9.

Bonstrom BC, Sensel MR, Sather NH, Gaynon PS, La

MK, Johnston K, et al. Dexamethasone verses prednisolone and

daily oral verses weekly intravenous mercaptopurine for patients

with standard-risk acute lymphoblastic leukemia: A report from

the childrens cancer group. Blood 2003;101:3809–17.

Laningham FH, Kun LE, Reddick WE, Ogg RJ, Morris

EB, Pui CH. Childhood central nervous leukemia: historical

perspectives, current therapy, and acute neurological sequelae.

Neuroradiology 2007;49:873–88.

Ritcley AK. The pediatric oncology group: Supportive Care

Manual. London: Smithkline Beecham; 1996.

Wheeler K, Cleesells JM, Bailey CC, Richards SM. Treatment

related deaths during induction and in first remission in ALL

MRC UKALL X. Arch Dis Child 1996;74:101–7.

Pui Ch, Campana D, New definition of remission in childhood

acute lymphoblastic leukemia. Leukemia 2000;14:783–5.

Steinherz PG, Gaynon PS, Breneman JC, Cherlow

JM, Grossman NJ, Kersey JH, et al. Cytoreduction and

prognosis in acute lymphoblastic leukemia-the importance of

early marrow response: report from the Childrens Cancer

Group. J Clin Oncol 1996;14:389–98.

Urban C, Benesch M, Lackner H, Schwinger W, Kerbl

R, Gadner H. The influence of maximum supportive care on

dose compliance and survival. Single-center analysis of

childhood acute lymphoblastic leukemia and non-Hodgkin’slymphoma treated within 1984–1993. Klin Padiatr

;209:235–42.

Downloads

Published

2009-12-01