Survival of Childhood Acute Lymphoblastic Leukemia: Results of Therapy at Tata Memorial Hospital, Bombay, India

Abstract

The purpose of this study was to analyze the outcome of patients who completed therapy for acute lymphoblastic leukemia (ALL) and to study the role of an aggressive induction regimen in preventing post therapy relapses. Four hundred and twenty-two patients with ALL who completed therapy during the period 1975-1991 were followed. Two hundred and sixty patients received the aggressive MCP 841 protocol and 162 patients received various other less aggressive treatment regimens. Patients were followed with periodic examination and complete blood counts. The incidence of post therapy relapse was 27% in the less aggressive protocols and 15% in the MCP 841 protocol (p = 0.001). An higher percentage of relapses was seen in males (p = 0.05) and 89% relapses occurred within two years of stopping therapy. The relapse rate after 5 years of cessation of therapy was 0.59%. In conclusion, aggressive induction therapy is the most crucial factor in predicting relapses following cessation of therapy in ALL patients. However, relapses are unlikely to occur five years post therapy.

Acute lymphoblastic leukemia, the Indian scenario

“…An array of clinical and biological features have been identified as prognostically significant in childhood ALL, including age, presenting leukocyte count, Immunophenotypic, chromosomal abnormalities, the presence of overt central nervous system leukemia and the rapidity with which the patients demonstrate a response to initial induction chemotherapy. [4][5][6] Risk factors are utilized for stratification of therapy. [6][7][8] More intensive therapies are administered to patients considered to have the highest risk of relapse.…”

“…Although there are multiple studies performed across the world, there is paucity of literature available on the risk factors, pattern of relapsed disease and outcome of children with ALL in India. [4][5][6] With this background we conducted a study to assess the various prognostic factors and the impact they have on the outcome in children treated for ALL in our institute focusing on Immunophenotypic and Cytogenetics In the 186 patients that opted for treatment the status of blasts in peripheral blood at day 8 and bone marrow status at day 33 was assessed to determine the response to therapy. The outcome in terms of survivor and nonsurvivor was determined.…”

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

“…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.…”

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.…”