[Advances in the treatment of children with high risk acute lymphoblastic leukemia (ALL) treated with modified "NEW YORK" protocols between 1987 and 2002].
From 1981 to 1986, in children with ALL and initial WBC > or = 50,000/mm3, over 6-year disease-free survival was significantly lower (33%) than in children with WBC < 50,000/mm3 (60%). In attempt to improve this unsatisfactory results, three modified American protocols named: "New York", "New York I", and "New York II", "New York I", and "New York II" were introduced consecutively in the centers of Polish Pediatric Leukemia Lymphoma Study Group (respectively, in 1987, 1997, and 1999). The treatment results achieved in three consecutive therapeutic groups of children with ALL and initial WBC > or = 50,000/mm3: group I--213 children (1987-1996), group II--58 children (1997-1999), and group III--52 children (1999-2001) are presented. The observation was completed in December 31, 2002. In three evaluated groups the first complete remissions (CRs) were achieved in 90.6%. 94.8%. and 94.2% of patients, respectively. Relapses occurred in 71 patients of group I (37%), in 9 patients of group II (16%), and in 6 patients of group III (12%). The complications of treatment caused death in 7 children of group I, in 1 child of group II, and in 2 children of group III. Eighty-one (38%), 11 (18.9%), and 9 (17.3%) patients, respectively, died due to progression of disease. The event-free survival (EFS) in three evaluated groups did not depend on age of children and WBC. The rates of 2-, 5-, and 10-year event-free survival (EFS) in group I were: 69.9%, 55.3%, and 53.6%, respectively and the rates of 2- and 5-year EFS in group II were: 80.7% and 72.7%, respectively. The rate of 2-year EFS in group III was 71.6%. The analysis of achieved treatment results in three evaluated groups shows the gradual improvement of the prognosis in children with ALL and initial WBC > or = 50,000/mm3 treated with the use of modified protocols "New York" and "New York I" in comparison with patients treated before 1987. Longer observation is needed for evaluation of efficacy and complications of "New York II" protocol.
Klinika Onkologii i Hematologii Dzieciecej P-A Instytutu Pediatrii Wydziału Lekarskiego Uniwersytetu Jagiellońskiego w Krakowie. 30-663 Kraków, ul, Wielicka 265.
Walentyna
W
Balwierz
Angelina
A
Moryl-Bujakowska
Szymon
S
Skoczeń
Katarzyna
K
Pawińska
Anna
A
Balcerska
Anna
A
Płoszyńska
Alicja
A
Chybicka
Grzegorz
G
Dobaczewski
Katarzyna
K
Juszczak
Jacek
J
Wachowiak
Katarzyna
K
Derwich
Jerzy
J
Kowalczyk
Hanna
H
Wiśniewska-Slusarz
Michał
M
Matysiak
Agnieszka
A
Krauze
Roma
R
Rokicka-Milewska
Katarzyna
K
Pawelec
Danuta
D
Sońta-Jakimczyk
Aleksandra
A
Łuszczyńska
Renata
R
Tomaszewska
Mariusz
M
Wysocki
Jan
J
Styczyński
Violetta
V
Swiatkiewicz
D002648:Child; D002986:Clinical Trials as Topic / Q000639:trends*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D012008:Recurrence; D012307:Risk Factors