Abstract
The appropriate duration of therapy for childhood ALL remains controversial. 82 children(M:F, 47:35) with ALL were diagnosed between 1965-1975. Forty (49%)children, including 18 males,remained in complete continuous remission (CCR) at 3 years. Between the third and fifth years of therapy, 3 males and 3 females relapsed. The sites of initial relapse were the CNS in 5(4 had received CNS prophylaxis) and a simultaneous marrow and testicular relapse in the sixth. Five were initially high risk patients by age( 8 years)or white count(≥30,000/mm3) criterian. One additional child died, in remission, of varicella complications. 33 patients (40%) remained in CCR at least 5 years. They had received chemotherapy for a median of 61 mos. Followup times off therapy ranged from 6-178 mos (median 36+ mos). One boy in this group subsequently relapsed in the marrow 16 months after therapy ended. We conclude that the relapse rate of 17.5% (7/40) after 3 years of CCR is comparable to the 20% relapse rate reported by St. Jude Children's Research Hospital (NEJM 300:269, 1979), although our patients received therapy for an additional 2+ years. Continuing therapy beyond 3 years would therefore seem to subject patients to continued potential morbidity without improving ultimate prognosis.
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