Abstract
Until recently, children who suffered from relapse of acute lymphoblastic leukemia (ALL) had very bad prognoses. The authors summarize their ten-year experience in the therapy of relapse and evaluate the role of modern intensive chemotherapy and bone marrow transplatation (BMT) for the improvement of prognosis.
Between 1986 and 1995, 44 children with first relapse of ALL were treated according to different protocols. Twenty four children suffered from isolated bone marrow relapse, 4 children from CNS leukemia and 9 boys from testicular leukemia.
Combined relapse in bone marrow and CNS or testes was diagnosed in 7 children. Thirty eight children (86%) achieved second remission.
The overall 8-year event-free survival was 20%. Median duration of 2nd remission was 15 moths.
The best prognosis was seen in boys with isolated testicular leukemia (EFS 56%) and in children with combined relapses (EFS 43%). The outcome in children with isolated bone marrow relapse (EFS 4%) and CNS leukemia was very poor.
Duration of first remission over 30 months (EFS 30%) and diagnosis of relapse after 1990 (EFS 30%) were associated with more favorable outcome. Five children were treated with allogeneic BMT and all are alive in remission (median follow-up 28 months).
Five from 6 children treated with autologous BMT suffered from relapse. With the current treatment regimens long-lasting second remission can be achieved in about one third of children with ALL.