Outcome of risk adapted therapy for relapsed/refractory acute lymphoblastic leukemia in children

Abstract 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 seco...

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Bibliographic Details
Published in:Leukemia & lymphoma 2013-03, Vol.54 (3), p.547-554
Main Authors: Belgaumi, Asim F., Al-Seraihy, Amal, Siddiqui, Khawar S., Ayas, Mouhab, Bukhari, Asem, Al-Musa, Abdulrahman, Al-Ahmari, Ali, El-Solh, Hassan
Format: Article
Language:English
Subjects:
acute lymphoblastic leukemia
Adolescent
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Child
Child, Preschool
Combined Modality Therapy
Cytarabine - administration & dosage
Drug Resistance, Neoplasm
Female
Hematopoietic Stem Cell Transplantation
Humans
Infant
Kaplan-Meier Estimate
Male
Multivariate Analysis
Pediatric
Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology
Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy
Prospective Studies
Recurrence
relapse
Remission Induction
Risk Factors
therapy
Treatment Outcome
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Summary:Abstract 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.
ISSN:1042-8194
1029-2403
DOI:10.3109/10428194.2012.719616