Outcome of risk adapted therapy for relapsed/refractory acute lymphoblastic leukemia in children
| Autor: | Hassan El-Solh, Asem Bukhari, Khawar Siddiqui, Amal Al-Seraihy, Asim F. Belgaumi, Abdulrahman Al-Musa, Mouhab Ayas, Ali Al-Ahmari |
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| Rok vydání: | 2012 |
| Předmět: |
Male
Cancer Research Pediatrics medicine.medical_specialty Adolescent Lymphoblastic Leukemia Kaplan-Meier Estimate Recurrence Risk Factors hemic and lymphatic diseases Antineoplastic Combined Chemotherapy Protocols medicine Humans Prospective Studies Intensive care medicine Child Childhood Acute Lymphoblastic Leukemia business.industry Remission Induction Cytarabine Hematopoietic Stem Cell Transplantation Infant Hematology Precursor Cell Lymphoblastic Leukemia-Lymphoma Combined Modality Therapy Treatment Outcome Oncology Drug Resistance Neoplasm Child Preschool Relapsed refractory Multivariate Analysis Female business |
| Zdroj: | Leukemialymphoma. 54(3) |
| ISSN: | 1029-2403 |
| Popis: | Results of second-line therapy for childhood acute lymphoblastic leukemia (ALL) remain suboptimal, particularly for high-risk groups identified using timing and site of relapse. We report results of prospectively collected data for pediatric patients with ALL who received risk adjusted second-line therapy. The 59 patients who failed first-line ALL therapy included 36 (61%) with bone marrow (BM), 13 (22.1%) with isolated extramedullary (EM) and 10 (16.9%) with BM + EM relapse. Some 51.8% patients were reinduced with high dose cytosine arabinoside (HDAraC)-based and 48.2% with standard four-drug regimens. In all, 38/56 (67.9%) achieved a complete remission (CR) with second-line therapy; the overall CR rate was 78.6% and was not associated with CR1 duration (p =0.8). Three-year overall survival (OS) was 45.3%, and was 61.4% for those achieving a CR. No risk group benefited from HSCT over chemotherapy. Patients with isolated EM relapse beyond 18 months of CR1 and BM relapse beyond 12 months off-therapy had an excellent outcome (OS 91.7%), identifying a particularly good-risk cohort. Patients not in this category continue with poor outcome even following hematopoietic stem cell transplant. |
| Databáze: | OpenAIRE |
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