title: Modified BFM protocol for childhood acute lymphoblastic leukemia: a retrospective analysis.
abstract: Childhood acute lymphoblastic leukemia (ALL) has a 5-year disease-free survival (DFS) of more than 70%. This fact is not reflected in developing countries due to the lack of proper supportive care. A modified version of the standard Berlin-Frankfurt-Munich (BFM) protocol for pediatric ALL was developed to achieve balance between toxicity and favorable response rates. Modification included a dose reduction of asparaginase and methotrexate during the consolidation and reinduction phase. Forty-two patients younger than 15 years of age were put on the modified BFM protocol between November 1990 and November 1993. Thirty-nine patients were 2-10 years of age and 3 were older than 10 years. Male to female ratio was 3.2:1. 71.4% had L1 and 28.6% had L2 morphology. Univariate analysis factors revealed central nervous system (CNS) involvement and late complete remission (CR) during induction as poor prognostic factors. In multivariate analysis, CNS disease (P < 0.0083) was the only prognostic variable for prolonged DFS. All patients went into CR. Eleven patients have relapsed. Life table analysis of these patients shows a 59.4% probability of overall survival (OS) and a 52.5% probability of DFS at 48 months.
authors.affiliation: Allama Iqbal Medical College, Lahore, Pakistan.
authors.forename: Z
authors.initials: Z
authors.lastname: Aziz
authors.forename: M
authors.initials: M
authors.lastname: Zahid
authors.forename: R
authors.initials: R
authors.lastname: Mahmood
authors.forename: S
authors.initials: S
authors.lastname: Maqbool
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003630:Daunorubicin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D013534:Survival; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D001215:Asparaginase; D011241:Prednisone; D003630:Daunorubicin