Remission In Childhood Acute Lymphoblastic Leukemia Research Articles

Correlation with serum Lactate dehydrogenase level and Hematological parameters before and after induction of remission in childhood Acute lymphoblastic leukemia- A prospective study

The relationship between serum LDH (lactate dehydrogenase) and the course of neoplasia had been well established in different studies. It might be a promising tool as assessing serum is easy, readily available and cheap in the prognosis of childhood Acute Lymphoblastic Leukemia (ALL). This study is aimed to evaluate the role of serum LDH before and after induction of remission in childhood ALL. This study was conducted at the Department of Pediatrics, Rajshahi Medical College Hospital, and Rajshahi for a period of two years. Total 30 children aged from 1-12 years newly diagnosed cases of ALL were included. Each patient underwent clinical evaluation and relevant investigations. All information was recorded in a separate case record form. Collected data were analyzed using the statistical software SPSS 23. Mean age of the studied children was 5.03±3.17 years. Male children were 66.7% and female children were 33.3%. Mean value of serum LDH was significantly lower at 29th days of induction of remission compared to the value before chemotherapy (432.40±310.52 U/L vs. 829.10±345.58 U/L, p<0.05). Mean peripheral blast cell also reduced after chemotherapy (30.03±16.41% Vs. 0.37±0.96%). Pearson correlation model showed strong positive correlation between LDH level and bone marrow blast cell at both before and after chemotherapy (r> +0.75, p<0.001). This study observed significant reduction of LDH after chemotherapy and positive linear relation with peripheral blast cells. TAJ 2023; 36: No-2: 83-92

Relationship of Initial Lactate Dehydrogenase (LDH) with initial tumor load and bone marrow remission in childhood Acute Lymphoblastic Leukemia (ALL)

This was a prospective interventional study conducted in the department of pediatric hematology and oncology in BSMMU during the period from January 2004 to June 2005. The objectives of the study were to observe- The effects of initial tumor load on initial LDH and the relation of initial LDH levels with response to remission induction chemotherapy in childhood ALL. All the children from one to fourteen years with the confirmed diagnosis of ALL, irrespective of their sex, were included in the study. Out of total 40 cases 21 of them were male and 19 female. As much as 60% of them were from rural areas and 40% city dwellers. Before starting chemotherapy for induction of remission complete clinical and laboratory assessments were done. Evaluation was also performed on 7th, 14th, 21st and 28th days after the starting of treatment. All the assessments were done to see whether the cases were in bone marrow remission or not. Initial LDH level was found to have direct correlation with initial WBC as well as initial blast cell count. Mean LDH levels differed significantly between the group having initial hyperleukocytosis (50x10(9)/L) and that below 50x10(9)/L. Mean LDH level was also significantly higher in the cases of ALL with IBC >25x10(9)/L than the group with IBC below 25x10(9)/L. The cases with very high initial LDH level responded poorly to dexamethasone monotherapy as well as to polychemotherapy in induction of remission in childhood ALL. Level of initial LDH was observed to be a significant indicator of outcome of induction of remission in childhood Acute Lymphoblastic Leukemia. DOI: http://dx.doi.org/10.3329/cbmj.v2i1.14174 Community Based Medical Journal Vol.2(1) 2013 3-8

Clinical significance of minimal residual disease in childhood acute lymphoblastic leukemia. European Organization for Research and Treatment of Cancer--Childhood Leukemia Cooperative Group.

The implications of the detection of residual disease after treatment of acute lymphoblastic leukemia (ALL) are unclear. We conducted a prospective study at 11 centers to determine the predictive value of the presence or absence of detectable residual disease at several points in time during the first six months after complete remission of childhood ALL had been induced. Junctional sequences of T-cell-receptor or immunoglobulin gene rearrangements were used as clonal markers of leukemic cells. Residual disease was quantitated with a competitive polymerase-chain-reaction (PCR) assay. Of 246 patients enrolled at diagnosis and treated with a uniform chemotherapy protocol, 178 were monitored for residual disease with one clone-specific probe (in 74 percent) or more than one probe (in 26 percent). The median follow-up period was 38 months. The presence or absence and level of residual leukemia were significantly correlated with the risk of early relapse at each of the times studied (P<0.001). PCR measurements identified patients at high risk for relapse after the completion of induction therapy (those with > or =10(-2) residual blasts) or at later time points (those with > or =10(-3) residual blasts). Multivariate analysis showed that as compared with immunophenotype, age, risk group (standard or very high risk), and white-cell count at diagnosis, the presence or absence and level of residual disease were the most powerful independent prognostic factors. Residual leukemia after induction of a remission is a powerful prognostic factor in childhood ALL. Detection of residual disease by PCR should be used to identify patients at risk for relapse and should be taken into account in considering alternative treatment.

Bone marrow transplantation versus chemotherapy for maintenance of second remission of childhood acute lymphoblastic leukemia: A study of the children's cancer group (CCG‐1884)

Background Maintenance of second remission of childhood acute lymphoblastic leukemia (ALL) with intensive chemotherapy is often unsuccessful. The major cause of treatment failure is relapse. Materials and Methods Of 96 children with ALL who relapsed in the marrow while on or within 1 year of completing initial therapy, 62 achieved a second remission. Nineteen patients underwent bone marrow transplantation in second remission, 11 from a human leukocyte antigen (HLA)-matched related donor, seven using autologous marrow, and one from a matched unrelated donor. The event-free survival (EFS) of transplanted patients was compared to that of patients treated with intensive chemotherapy using high-dose cytarabine, vincristine, escalating dose methotrexate, L-asparaginase, and an anthracycline (daunorubicin or idarubicin). Only those patients treated with chemotherapy who survived in second remission up to the mean time that patients were transplanted (135 days) were included in the control group (33 of 43 patients who achieved second remission). Results The actuarial 2-year event-free survival of transplanted patients is 37 ± 22% (95% C.I.) compared to 18 ± 13% for chemotherapy-treated patients (P = 0.017). EFS for allo-transplant recipients was similar to that for auto-transplant recipients. Duration of initial remission was a strong predictor of the outcome of retrieval therapy. Patients whose initial remission was greater than 3 years had better EFS after achieving second remission (five of 11 still in remission, compared to four of 41 patients whose initial remission was less than 3 years). Adjustment in the multivariate analysis for duration of initial remission did not diminish the benefit of transplant over chemotherapy. Conclusions While there remains considerable possibility for further improvement in EFS after achieving second remission of childhood ALL, bone marrow transplant is superior to chemotherapy in maintaining second remission. Med. Pediatr. Oncol. 29:534–540, 1997. © 1997 Wiley-Liss, Inc.