37% long-term survival of children with ALL relapse by risk-stratified salvage therapy - Results of trial ALL-REZ BFM 87 after 15 years of follow-up

Abstract

Cure rates of childhood ALL improved distinctly in the past decades. Nevertheless, ca. 20% of the patients relapse, and their prognosis is clearly worse. We describe design and long term results of the multicenter trial ALL-REZ BFM 87 for children with first relapse of ALL. Patients (n=207) were stratified into three risk-groups (RG, A: early bone marrow (BM) relapse, B: late BM relapse, C: isolated extramedullary relapse), alternatively, patients with a poor prognosis (very early BM relapse or any relapse of T-ALL) could be enrolled to an experimental pilot regimen (P88). Treatment consisted of multiagent chemotherapy, cranial irradiation, and conventional maintenance therapy, or stem cell transplantation (SCT) in a subset of patients. The pEFS and pSRV at 15 years was .30±.03 and .37±.03, respectively, and differed significantly with regard to RG (A: .18±.05 and .20±.05; B: .44±.05 and .52±.05; C: .34±.05 and .42±.10; P88: .0 and .04±.04). In univariate and multivariate analyses, time to relapse, immunophenotype, and SCT proved to be significant predictors of EFS. SCT was effective in a subset of patients.