Outcome after Relapse in Childhood Acute Lymphoblastic Leukaemia - Results of a Single Center for a Period of 15 Years.

Abstract

Approximately 25–30 % of children newly diagnosed with acute lymphoblastic leukemia (ALL) will eventually experience leukemic relapse. Bone marrow is the most common site of recurrence. Usually achieving a durable second remission is complicated by toxicity and resistance of the disease. Here we documented our patients in order to see the prognosis of relapsed pediatric ALL cases.RESULTS. From August 1990 to August 2005 children diagnosed with ALL and treated with BFM based protocols in Cerrahpasa Medical Faculty Pediatric Hematology-Oncology Department were enrolled to this study. There were 225 children aged median 6 years( 3 months–18 years) (136 boys/89 girls), 28 % SR, 50 % MR, 22 % HR. The whole group EFS is 72,6 % and RFI 81,8 %. Twenty-nine (12,8 %) patients were relapsed. Bone marrow recurrences were isolated in 19 patients, and combined with an extramedullary site in 8 patients (4 CNS, 2 testis, 1 retinal,1 dermal). Only two patients had isolated extramedullary site (testis) relapse. The median time to recurrence was 23 months (range 4–128 months). Five patients refused a secondary treatment. Of 24 chemotherapy given patients, 6 patients were lost just after induction therapy due to toxicity before a reliable remission evaluation was done. In three early relapses a second remission could not be attained. Twenty-one patients (72.4 %) achieved a second remission (median length, 4 months; range, 1–114 months)( mean16 ± 80 months). The 5-year survival probability among all patients was 27.2 % ± 8.2 %. Of 8 surviving patients, 3 are in remission more than 5 years, 3 are in remission 2–5 years of period and only 2 less than 1 year. One patient who relapsed for second time is in 3th remission for 65 months period. Bone marrow transplantation was the done for only 3 patients, one is very newly done, the other two relapsed after engrafmant and were lost.CONCLUSIONS. Despite acceptable long-term second EFS rates for a minor group of patients, childhood ALL recurrences signal a poor outcome being the problem of childhood ALL therapy.