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KMID : 0366220080430040238
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Korean Journal of Hematology
2008 Volume.43 No. 4 p.238 ~ p.246
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Effect of Treatment Modification by Initial Response in High-Risk Childhood Acute Lymphoblastic Leukemia
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Yoon Jong-Hyung
Kim Eun-Kyung
Park Jeong-Ah
Kang Hyoung-Jin
Shin Hee-Young
Ahn Hyo-Seop
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Abstract
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Background: Bone marrow (BM) finding on day 7 of induction chemotherapy is one of major prognostic factors in acute lymphoblastic leukemia (ALL). M3 marrow (blast ＞25% on BM examination) on day 7 is associated with lower survival rates, compared with M1 (blast ＜5%) or M2 (blast 5∼25%) marrow. Herein, we analyzed the effect of the augmented post-induction chemotherapy in patients with high-risk ALL with M3 marrow on day 7 BM examination.
Methods: Patients diagnosed as high-risk ALL and received modified Children’s Cancer Group (CCG)- 1882 induction chemotherapy between January 1996 and October 2005 at Seoul National University Children’s Hospital were analyzed. Patients with M1 or M2 marrow on day 7 were treated with modified CCG-1882A/B chemotherapy from consolidation and patients with M3 marrow were treated with modified CCG-1882C chemotherapy.
Results: Total 44 patients (29 with modified CCG-1882A/B and 15 with modified CCG-1882C) were analyzed. The overall survival (OS) and 5-year event-free survival (EFS) were 86.2% and 81.9%, respectively. The OS of the patients who were treated with modified CCG-1882A/B protocol (88.9%) was not different from that of the patients with modified CCG-1882C protocol (80.0%) (P=0.3256). Also, there was no statistical difference in 5-year EFS of both groups (85.4% vs 72.7%, P=0.2117).
Conclusions: There was no difference between survival of the patients with M1/M2 marrow on day 7 BM examination and M3 marrow after augmented post-induction chemotherapy in patient with high-risk ALL. We suggest that poor prognosis of high-risk ALL with poor initial response could be overcome by augmented post-induction chemotherapy.
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KEYWORD
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High-risk acute lymphoblastic leukemia, Augmented post-induction chemotherapy, Childhood, Response, Prognosis, Survival rate
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