[Acute lymphoblastic leukemia in children. Long survivals obtained with protocols C2-72 and D-74 (1972-1977)].
Between 1972-1977, 92 patients with acute lymphoblastic leukemia, between 0 and 14 years of age, were treated with C2-72 and D-74 protocols. Induction treatment consisted of prednisolone (PRED)-vincristine (VCR) with the addition of daunorubicin (prot. C2-72) or asparaginase (prot. D-74). In both protocols, preventive therapy on the CNS consisted of cranial irradiation (24 Gy) and 5 doses of methotrexate i.t. (MTX). For the maintenance phase in protocol C2-72, three combinations: mercaptopurine (MP)-MTX, MP-Ara.C and MTX-cyclophosphamide, were sequentially administered for 3 years, with reinductions of PRED-VCR every three months. In protocol D-74, only MP-MTX was used for 3 years; the random half of the patients also received "reinductions". In protocol C2-72, BCG was administered by scarifications for 2 years to patients in remission after 36 months; in D-74, the random-half patients received BCG and irradiated allogeneic blasts for one year. The other half of the patients received no other treatment. The overall disease-free survival rate is 45.6% with a duration of between 84 and 156 months. Only one death occurred after 7 years. In protocol C2-72, 9 of 26 initial patients (34.6%) and in protocol D-74, 33 of 66 initial patients (50%) are still alive, off treatment and with no sign of disease. Ten patients (10.8%) died in continuous remission of infection (8) or toxic encephalopathy (2); five deaths were caused by "Pn. carinii". The incidence of meningeal relapse was 11% and isolated testicular relapse in males 15.7%; moreover, in 6 of the 22 boys in remission, programmed testicular biopsy showed interstitial leukemic infiltrates. Analysis of initial risk factors permitted the establishment of a risk index (r.i.): in cases with a r.i. below 3 (76% of cases) the survival rate was 53%; in the group with a higher r.i. (24%), it was 22%. Further conclusions of this study were: the lack of effectivity of "reinductions" and immunotherapy and proof of a higher rate of relapses in males mainly owing to isolated testicular relapse.
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage; D001500:BCG Vaccine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007223:Infant; D007231:Infant, Newborn; D007945:Leukemia, Lymphoid / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000517:prevention & control; D015122:Mercaptopurine / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage; D011897:Random Allocation; D013736:Testicular Neoplasms / Q000473:pathology; D014750:Vincristine / Q000008:administration & dosage
D001500:BCG Vaccine; D003561:Cytarabine; D014750:Vincristine; D003520:Cyclophosphamide; D011239:Prednisolone; D015122:Mercaptopurine; D001215:Asparaginase; D008727:Methotrexate; D003630:Daunorubicin
Leucemia aguda linfoblástica en niños. Largas supervivencias obtenidas con los protocolos C2-72 y D-74 (1972-1977).