Improved treatment results in boys with overt testicular relapse during or shortly after initial therapy for acute lymphoblastic leukemia. A pediatric oncology group study

Abstract

Boys with acute lymphoblastic leukemia (ALL) who have overt testicular relapse (OTR) during initial continuation chemotherapy or within 6 months thereafter have poor outcomes, with long-term survival similar to patients with marrow relapse during treatment. In April 1983, the Pediatric Oncology Group (POG) adopted for these patients an intensive treatment protocol (POG 8303) consisting of a four-drug systemic reinduction (prednisone, vincristine, daunorubicin, and asparaginase), a brief intensive consolidation phase with teniposide and cytarabine, and a 2-year program of continuation chemotherapy with weekly rotating drug pairs (vincristine/cyclophosphamide and teniposide/cytarabine) with or without (by randomization) four-drug reinforcement pulses every 16 weeks. Bilateral testicular radiation (2600 cGy) was administered during reinduction, and intrathecal chemoprophylaxis was given every 4 to 6 weeks. Among 38 eligible study patients with OTR, 5 had prior or concominant extramedullary relapse in other sites. The median duration of complete remission before OTR was 27 months (range, 10 to 42 months). All 38 patients achieved clinical remission after reinduction. Three patients withdrew while in remission, 22 had another relapse (12 marrow, 5 central nervous system (CNS), 2 testicular, 1 retroperitoneal, 1 prostate, and 1 eye), and 13 (34%) remain in complete remission from 32+ to 74+ months after OTR (median, 53+ months). Eighteen patients had their therapy electively discontinued, and five relapses occurred thereafter. These results are superior to those observed in patients with first marrow relapse treated with the same protocol. Approximately one third of patients with OTR treated with POG protocol 8303 exhibit prolonged second remissions with the potential for cure.

Isolated late testicular relapse of B‐cell acute lymphoblastic leukemia treated with intensive systemic chemotherapy and response‐based testicular radiation: A Children's Oncology Group study

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The major impact of isolated testicular relapse (ITR) is the high incidence of subsequent systemic relapse, though this appears to be directly influenced by length of first clinical remission (CR1). [18][19][20][21][22][23] In POG 8304 (1983)(1984)(1985)(1986)(1987)(1988)(1989), the overall 4-year event-free survival (EFS) among males with occult testicular relapse at completion of therapy was 53 ± 8%, compared to 84 ± 10% for males with late overt ITR (6 months or greater following completion of therapy). 18,19 A more recent analysis of the CCG database (CCG 1881, CCG 1882, CCG 1901, CCG 1883, CCG 1922, unpublished results) showed a trend to poorer outcome for those with CR1< 18 months versus >18 months (5-year EFS 43% vs. 61%, respectively), though numbers are small and do not reach statistical significance.…”

Extramedullary relapse of acute lymphoblastic leukemia in childhood to the prostate

“…On the other hand , Buchanan et al 2 studied the outcome of 38 boys who had overt testicular relapse of ALL and reported that, after clinical remission, 22 cases had another relapse involving the bone marrow in 12, CNS in five, testes in two, retroperitoneal in one, prostate in one, and eye in one. In another paper, Quien et al 3 has reported a case of a 67-year-old male with primary extramedullary ANLL of the prostate.…”

Hematopoietic Stem Cell Transplantation for Leukemia

“…Outcome after short CR1 duration (<12–18 months) is very poor, as is the prognosis for individuals who are unable to achieve a second remission. Those with isolated extramedullary relapse fair better than those with marrow relapse [48,49]. …”