The clinical course and other distinctive features of five children who developed a testicular relapse 4 months to 25 months after the diagnosis of acute nonlymphoblastic leukemia (ANLL) are described. The chief presenting feature at relapse was painless testicular enlargement, as is also seen in children with acute lymphoblastic leukemia who relapse in the testes. By French-American-British convention, the malignant cells were classified as M4 (myelomonoblastic) in four cases and M2 (myeloblastic) in one. All children received a course of multiagent reinduction chemotherapy and all but one received local irradiation to the testes. Only one of these children, whose relapse was a late event after elective cessation of therapy, is a long-term survivor. A comparison with six previously published cases shows similar clinical characteristics and outcome. Given the poor responses of such patients to conventional treatment, it seems worthwhile to consider the use of intensive reinduction chemotherapy with concomitant bilateral testicular irradiation followed by remission intensification and an autologous or allogenic marrow transplant. Cancer 662095-2098,1990, ESTICULAR RELAPSE is well-characterized in child-T hood acute lymphoblastic leukemia (ALL).',' In contrast, there have been few reports of relapse in the testes among boys with acute nonlymphoblastic leukemia (ANLL), perhaps because of the short disease-free survival associated with this form of leukemia. With improved therapy for ANLL, the frequency of isolated relapse in the testes is likely to increase. Adequate management of these patients will depend on better appreciation of the clinical course of disease that has relapsed in this site. We describe here the clinical characteristics, treatment, and outcome of five patients with ANLL that relapsed in the testes, and present specific treatment recommendations based on these observations.
Patients and Methods
Among 169 boys with ANLL treated at St. Jude Children's Research Hospital (SJCRH, Memphis, TN) and the University of California, Davis, from January 1976 to December 1988, five (3%) had testicular relapse. The diagnosis was established by tissue biopsy in each case. Treatment consisted of intensive alternative multiagent chemotherapy, with or without testicular irradiation, administered according to institutional protocol^.