Abstract
examinations. They reported a higher proportion of clinically unsuspected relapses (58 of 84), but defined relapse to include M-2. In 50 of the 84 relapses there was less than 25% blasts in the bone marrow. They found no difference, however, in the success of second remission induction or second remission duration, and concluded that bone marrow investigation for detecting early relapse in acute lymphatic leukemia of childhood may be unnecessary. There are two purposes for the performance of studies in patients participating in clinical trials: (1) the benefit of the patient, and (2) to compare treatment regimens accurately. For clinical care, it would appear that the majority of relapses will be suspected on clinical or peripheral blood criteria. At present there are no data to suggest that earlier detection of relapse will change curability. It is also highly unlikely that the performance of bone marrow aspiration at frequent intervals (or any interval) will improve the statistical comparability of treatment plans, because 72% of relapses occurred within one month of finding a previous M-1 bone marrow and were clinically suspected prior to the aspiration. REFERENCES 1. Watson DK, Robinson AE, Bailey CC: A reappraisal of routine marrow examination therapy of acute lymphoblastic leukemia. Arch Dis Child 56:392, 1981. 2. Haworth C, Hippleston AD, Morris-Jones PH, et al: Routine bone marrow examination in the management of acute lymphoblastic leukaemia of childhood. J Clin Pathol 34:483, 198I. 3. Leikin SL, Brubaker C, Hartmann JR, etal : Criteria for chemotherapy in acute leukemia. Cancer 21:349, 1968. 4. Komp DM, George SL, Falletta J, et al: Cyclophosphamideasparaginase-vincristine-prednisone induction therapy in childhood acute lymphocytic and non-lymphocytic leukemia. Cancer 37:1243, 1976. 5. Berry DH, Pullen J, George S, et al: Comparison of prednisone, vincristine, methotrexate and 6-mercaptopurine vs vincristine and prednisone induction therapy in childhood acute leukemia. Cancer 36:98, 1975. 6. Cox DR: Regression models and life tables. J R Stat Soc 34:187, 1972.
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