All issues > Volume 42(3); 1999

Original Article

J Korean Pediatr Soc. 1999;42(3):383-389. Published online March 15, 1999.

Treatment Outcomes in Children with High-Risk Acute Lymphoblastic Leukemia

Kyu Chang KC Park¹, Ho Joon HJ Im¹, Sang Yun SY Ahn¹, Hahng H Lee¹

¹Department of Pediatrics, Hanyang University, College of Medicine, Seoul, Korea

Abstract

Purpose
: The survival rate of those with acute lymphoblastic leukemia(ALL) has been affected by several prognostic factors and previous reports show that a 4-year event-free survival(EFS) for high-risk(HR) group(Age≥10 years and/or WBC≥50,000/mm3 at diagnosis) was approximately 64%. We analyzed treatment outcomes and risk factors in HR-ALL.
Methods
: Medical records of 27 patients with HR-ALL diagnosed between May, 1985 and December, 1996 were reviewed. HR-ALL was treated with a modified Children's Cancer Group (CCG)-Berlin-Frankfurt-Münster(BFM) chemotherapy regimen with an additional end-intensification at the completion of chemotherapy.
Results
: Of 27 patients, 17(63%) were aged over 10 years, 16(59%) had high leukocyte counts of ≥50,000/mm3, and 17(63%) had low platelet counts of <100,000/mm3 at diagnosis. As for the FAB classification, 16 had L1, and 11 had L2. As for the immunophenotypes, 20(74.1%) were B- lineage, and 7(25.9%) were T-lineage. The median follow-up was 39 months(2wks-12.3year). The 5-year EFS for total HR-ALL patients was 74.1%. The 5-year EFS was 81.3% for children with FAB L1 morphology, 63.6% for FAB L2, 85.7% for T-cell ALL, and 70.0% for B-precursor ALL. Of 27 patients, 25 achieved remission, with a remission induction rate of 92.6%. During the follow-up period after remission, three relapses and two deaths occurred.
Conclusion
: Conventional chemotherapy with additional end-intensification showed relatively good treatment outcome in HR-ALL with 5-year EFS of 74.1%, but larger studies of prognostic factors are needed.

Keywords :Acute Lymphoblastic Leukemia, High-Risk Group, Event Free Survival Rate, End-Intensification Therapy