✦ LIBER ✦

Treatment of high-risk acute lymphoblastic leukemia in children using the AL851 and ALHR88 protocols: A report from the Kyushu-Yamaguchi children cancer study group in Japan

✍ Scribed by Matsuzaki, Akinobu; Ishii, Eiichi; Okamura, Jun; Eguchi, Haruhiko; Yoshida, Nobuyuki; Yanai, Fumio; Inoue, Toshiro; Miyake, Kazuaki; Ishihara, Takanobu; Tsuboi, Chizuru; Nibu, Keiko; Ueda, Kohji; Take, Hiromichi; Miyazaki, Sumio; Tasaka, Hideko

Publisher: John Wiley and Sons
Year: 1996
Tongue: English
Weight: 770 KB
Volume: 26
Category: Article
ISSN: 0098-1532
DOI: 10.1002/(sici)1096-911x(199601)26:1<10::aid-mpo2>3.0.co;2-y

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✦ Synopsis

A total of 125 children, who were diagnosed as having high-risk acute lymphoblastic leukemia (ALL), were treated with two consecutive protocols designated as AL851 (1985( -1988( ) and ALHR88 (1988( -1990)). All patients received induction therapy consisting of vincristine (VCR), prednisolone (PSL), daunorubicin (DNR), and I-asparaginase (I-Asp). In the ALHR88 protocol, the patients whose blasts in the bone marrow (BM) were 225% on day 14 of induction therapy and who were classified into T-cell type received additional cytosine arabinoside (AraC). After consolidation with intermediate-dose methotrexate (MTX), reinduction therapy including VCR, dexamethasone, and adriamycin followed by high-dose AraC was done for all patients. lntrathecal MTX and 24Cy of cranial irradiation were used to prevent central nervous system leukemia. A maintenance ther-apy consisting of 6-mercaptopurine, cyclophosphamide, MTX, DNR, VCR, and AraC was administered for 3 years after achieving a complete remission (CR). CR was achieved in 51/55 (92.7%) for AL851 and 68/70 (97.1%) for ALHR88. The 5-year event-free survival rates were 49.1 f 6.7% in AL851 and 62.5 f 6.1% in ALHR88. The factors related to a poor prognosis were a high initial leukocyte count of greater than 50 x 109/L (P < O.OOl), an L2 morphology of leukemic cells by FAB classification (P = 0.009), the chromosomal abnormality (P = 0.004) and high residual leukemic cells in BM (225%) on day 14 of induction therapy ( P < 0.001).

Taking these factors into consideration, more intensive protocols were started in 1990 for the patients with high-risk ALL.

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