Central nervous system disease in childhood acute lymphoblastic leukemia: prognostic factors and results of treatment.
In the five Nordic countries, 808 children 1 to 15 years of age (428 boys, 380 girls) were diagnosed with non-B acute lymphoblastic leukemia (ALL) from July 1981 through June 1986. Complete remission was achieved in 770 children (95%). Central nervous system (CNS) involvement at diagnosis was noticed in 34 children, of whom 26 achieved remission. Of these 26 patients 11 subsequently relapsed, 5 in the central nervous system. An interim analysis in January 1990 (observation time 3 1/2 to 8 1/2 years) revealed that isolated CNS relapse had occurred in 70 children (9.0%). Of these 70 patients, 12 out of 142 children (8.5%) had initially received irradiation and 58 out of 628 children (9.2%) only chemotherapy as CNS-prophylaxis. There was a significant higher risk for boys (12%) than for girls (6%) to relapse in the CNS compartment. Unfavorable prognostic factors for survival after isolated CNS relapse were short duration of first remission and male sex. In high-risk patients after an isolated CNS relapse, there was no difference in prognosis related to treatment with or without irradiation as initial CNS prophylaxis.
Kreuger
A
A
Department of Pediatrics, University Hospital, Uppsala, Sweden.
Garwicz
S
S
Hertz
H
H
Jonmundsson
G
G
Lanning
M
M
Lie
S O
SO
Moe
P J
PJ
Salmi
T T
TT
Schröder
H
H
Siimes
M A
MA
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D008297:Male; D010865:Pilot Projects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D012727:Sex Characteristics; D015996:Survival Rate