Abstract
The authors studied the outcome of a cohort of pediatric acute lymphoblastic leukemia (ALL) patients (33 children and adolescence) diagnosed and treated conforming to modern Chemotherapy Protocols (ALL ICBFM 2002, Interfant 06) in a single Center – Pediatric Clinic, Fundeni Clinical Institute, Bucharest, Romania. They analyzed the factors which determine the prognosis and the outcome of these patients in the course of multi-agent systemic chemotherapy to stand at the base of these Protocols: initial age, initial leukocyte count, blasts immunophenotype, cytogenetic and molecular abnormalities, initial response to cortisone, risk groups, time to obtain the complet remission, etc. Among the factors they discussed, a great value was proven to have the minimal residual disease (MRD) determination in certain check points of Protocols and revaluation of patients risk conforming to MRD values. Using the modern Protocols and continuously watching the evolution on therapy enable the authors to obtain results close to those of European and North American Pediatric Hematology Oncology Centers: OS 90.9% by 40 Mo and EFS 72.7% at the end of the same period of time.
Highlights
It is widely accepted that pediatric acute lymphoblastic leukemia (ALL) is a biologically heterogeneous disease. [1] This heterogeneity manifests in what concerns the results of therapy and the outcome.Modern pediatric ALL treatment Protocols employ risk-based therapy to reduce the toxicity in patients with low risk ALL, and to use aggressive therapy for those with a high risk of relapse and an unfavorable outcome.Corresponding author: PRACTICA MEDICALÅ – VOL. 10, NR. 4(42), AN 2015Newly diagnosed children are subjected to a Treatment Plan including chemotherapy via systemic and intrathecal administration and supportive care
We focused on influence of variables like gender, initial leukocyte count, blast’s phenotype, associated cytogenetic and molecular anomalies, initial response to cortisone, induction outcome, etc on overall and event-free survival (EFS)
We were able to demonstrate the value for predicting the response to therapy of such biological factors as: Age at diagnosis – the best prognosis was in the 1-6 yoa group, while the ALL children aged less than 1 y at diagnose had the worst prognosis; Initial leukocyte count (100,000/μL only 55.6% EFS at 40 Mo); Blast’s immunophenotype, with B-common ALL having the best outcome (81% EFS by 40 Mo), and pro-B the worst one; Associated cytogenetic and molecular anomalies – The impact of these biological variables is visible especially for HR group patients
Summary
It is widely accepted that pediatric ALL is a biologically heterogeneous disease. [1] This heterogeneity manifests in what concerns the results of therapy and the outcome.Modern pediatric ALL treatment Protocols employ risk-based therapy to reduce the toxicity in patients with low risk ALL (i.e. low risk of treatment failure), and to use aggressive therapy for those with a high risk of relapse and an unfavorable outcome.Corresponding author: PRACTICA MEDICALÅ – VOL. 10, NR. 4(42), AN 2015Newly diagnosed children are subjected to a Treatment Plan including chemotherapy via systemic and intrathecal administration and supportive care. [1,2,3] The principles of multiagent CxT are: combination of drugs, low therapeutic index and dose intensity [4]. In this period of time, as secondary effects of therapy some patients can develop life-threatening toxicities. Post-induction therapy – lasts 2-3 years and is used to remove any residual leukemia cells [1]. It includes early intensification, re-induction, late intensification and maintenance. We have to mention that using Protocols, all the patients were subjected to an uniform modality of treatment
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