Testicular infiltrates in children with acute lymphoblastic leukemia: A prospective study

Abstract

The incidence of testicular infiltrates in 68 boys with acute lymphoblastic leukemia in first remission (1974-81), was prospectively investigated through careful clinical examination and routine bilateral biopsies at 2-3 years of remission. All boys were under 14 years of age and they were treated with protocols D.74 and Pethema 7/78. Seven patients (10.3%) presented an isolated testicular relapse (ITR) during the chemotherapy period. In 13 of the 43 testicular biopsies (31%) leukemic infiltrates were found, and in another two findings were controversial. Three boys, two with previous negative biopsies, had an ITR 6 to 18 months after therapy was stopped. Finally, three others had simultaneous relapses in testes and bone marrow, one during chemotherapy and two after suppression. In all, 23 patients (33.8%) in first remission had overt or occult ITR. Overall estimated incidence rate of testes leukemia is 40% in all the groups. Incidence of early and occult ITR was higher in boys with initial WBC counts over 20 X 10(9)/1. Therapy in ITR generally consisted of local radiotherapy (20-25 Gy), a new induction treatment followed by 2-year maintenance treatment; in three patients with early ITR, orchidectomy was also performed and six were given a new CNS preventive treatment. Clinical course in the seven patients with early ITR was unfavourable in five, with subsequent hematological relapses and death; one had a long-term disease-free survival (80 + months) and the other was a recent case. Ten of the 13 patients with occult infiltrates continued in remission and four were off treatment with a follow-up of over 66 months. The three patients with late ITR were in 2nd remission at 8-18 months after a new cessation of therapy. It may be concluded from this study that prognosis in ITR is related to the phase of presentation: it is unfavourable in cases of early ITR, but in occult infiltrates, detected by routine biopsy, and in late ITR combined therapy is effective in most cases.

The clinical indications for identical pathogenesis of isolated and non‐isolated testicular relapses in acute lymphoblastic leukaemia

“…The present results confirm the earlier observations of good prognosis after isolated testicular relapse (19,25). Also the time of appearance of testicular relapse and the initial risk group of ALL were associated with the prognosis after testicular relapses, as in earlier observations (26,27). Because the material used did not provide information about routine testicular biopsies among patients with testicular relapse, the previously observed more favourable prognosis after late overt testicular relapses compared to that after occult testicular relapse could not be studied (28).…”

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

“…Leukocyte count at diagnosis (per pl) < 10,000 2 10,000 Length of initial complete remission (mo) < 18 2 (Treatment 1) or without (Treatment 2) PVDA reinduction pulses.…”

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

“…18–23 In POG 8304 (1983–1989), 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.…”

“…[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.…”