Four‐agent induction/consolidation therapy for childhood acute lymphoblastic leukemia: An Indian experience

Abstract

During 1984-1986, a total of 128 children with acute lymphoblastic leukemia (ALL) were treated with an induction-consolidation regimen consisting of doxorubicin, vincristine, cytosine-arabinoside, and prednisolone. One hundred two (80%) patients belonged to high-risk group. The complete remission rate for all the patients was 91%. The event-free survival at 5 years was 32.0% +/- 23%. On multivariate analysis the event-free survival and disease-free survival was not altered by age, sex, WBC count, platelet count, LDH level, and surface phenotype. Infection due to prolonged marrow aplasia was a common complication, leading to mortality of 8 patients during induction and 33 patients during first remission. The relapse rate has been 36% (42 patients). The predominance of high-risk ALL in the Indian population underscores the need for intensive therapy. Improved supportive care during induction and remission seems essential to decrease therapy-related mortality, leading to improved survival.

Pattern of Relapse in Childhood ALL: Challenges and Lessons From a Uniform Treatment Protocol

“…18,30,31 Although we observed a lower incidence of testicular relapse compared with other reports from India, data stemming from developed nations indicate very low (<2.8%) frequency of testicular relapse. [15][16][17]32 Five of 8 testicular relapses were posttherapy, supporting that testicular relapses tend to occur later. 18 These observations point to the need of revaluation of our protocol and incorporation of risk adjusted and high/intermediate dose methotrexate therapy upfront for testicular prophylaxis.…”

“…However, reports from several institutions in India suggest that the outcome is inferior to that achieved in the developed nations because of infection-related toxic deaths and increased incidence of relapse. [12][13][14][15][16][17] Although there are multiple studies performed across the world, there is paucity of literature available on the risk factors and patterns of relapsed disease of children with ALL in India.…”

Testicular relapse in childhood acute lymphoblastic leukemia: The challenges and lessons

“…[8][9][10] In a series of reports over different time periods, Advani et al observed that testicular relapse constituted 4.1%, 8.2% and 14.2% (isolated in 7.1%) of the relapsers. [11][12][13] Silverman et al and Chessels et al found that testicular relapse constituted 8.5 and 14.9% of the relapsers, respectively. [14,15] Relapse was confined to the testis in 4.3 and 10.1%, respectively.…”

Overt testicular disease at diagnosis in childhood acute lymphoblastic leukemia: prognostic significance and role of testicular irradiation

“…3 A marginally higher incidence of OTD and increased incidence of 'high-risk' (71.4%) in these patients, could be partly explained by an overall increased incidence of high-risk disease in an Indian setting. [8][9][10][11][12][13][14] Several Indian investigators have documented that over 65 to 70% of the cases of ALL could be categorized as 'high-risk', based on male gender, bulk disease, age, WCC at presentation and mediastinal/CNS disease. [8][9][10][11][12][13][14] In contrast, high-risk disease in encountered much less frequently is data stemming from developed nations.…”