Among 727 children with acute lymphocytic leukemia (ALL) observed at eight pediatric clinics in Italy in the years 1967-1974, 200 (27.5%) survived for more than five years after diagnosis. The proportion of long-term survivors rose significantly during the years 1970-1974 when aggressive therapeutic programs with curative intent were uniformly adopted in Italy (19.8% vs. 29.4%; P < 0.05). Clinical and laboratory data at diagnosis of the 200 long-term survivors were analyzed and compared with that of the 527 nonsurvivors. We found that, besides a leukocyte count greater than 50,000 cells/mm3, other factors such as early central nervous system CNS leukemia and the presence of mediastinal mass were predictive of a poorer prognosis for long-term survival. Life-table analysis revealed that the chance of long-term survival was significantly higher in those children who have survived for five years without relapse (82.9% vs. 24.1 %; P < 0.01). Although late initial relapse is always possible, if a child with ALL remains in continuous complete remission for at least nine years, it is likely that the patient is cured.
Cancer 489364-2367, 1981.
ITH THE ADVENT of modern therapeutic pro-W grams the survival of children with acute lymphocytic leukemia (ALL) has improved greatly. Recent studies indicate that leukemia-free survival for five years is possible in at least a third of newly diagnosed children with ALL treated with multiagent chemotherapy, prevention of central nervous system (CNS) localization and aggressive supportive measures.'-3
In an attempt to identify factors that may have contributed to a favorable prognosis in long-term ALL survivors, we have evaluated 200 children with ALL surviving more than five years after diagnosis. All children were under the care of experienced hematologists working at eight pediatric clinics in Italy (Table 1). This series comprises all of the patients with ALL seen at the listed clinics during those years.
From the Pediatric Branch of the Italian Association against Leukemia (AIL).