title: Could intensified treatment in childhood acute lymphoblastic leukemia improve outcome independently of risk factors?
abstract: OBJECTIVE
  Many risk-directed therapeutic protocols have been proposed in acute lymphoblastic leukemia (ALL). However, the relapse rates remain high. The effectiveness of each protocol depends on how quickly the clearance of blast cells is achieved. In an attempt to improve survival, by minimizing treatment toxicity and relapse rate, different therapeutic protocols were used every 3 yr in our Unit.
  
  
  METHODS
  During 1991-2000, 132 children with ALL were diagnosed in our Unit. Modified and intensified NY II and BFM protocols, in three consecutive periods [(Hematology/Oncology Pediatric Department of the University of Athens) HOPDA-91, HOPDA-94, HOPDA-97] were used.
  
  
  RESULTS
  At a median follow-up time of 96 months, the 8-year overall survival (OS) was 88% +/- 3%, whereas the event-free survival (EFS) was 85% +/- 3%. There was a significant increase of the 5-year EFS of the high-risk (HR) group through time (65% in HOPDA-91 vs. 80% in HOPDA-97), whereas EFS of the low risk (LR) group in HOPDA-97 was 96%. Five cases relapsed (3.8%), four of which underwent successful bone marrow transplantation. Fifteen children died (13 diagnosed by 1996, two in the last 4 yr).
  
  
  CONCLUSIONS
  Modification of the protocols significantly improved survival in both HR and LR groups. The intensified regimen in the LR group did not increase the adverse toxic events, but on the contrary was extremely effective.
authors.affiliation: Hematology/Oncology Unit, First Department of Pediatrics, University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece. ftzortza@med.uoa.gr
authors.forename: Fotini
authors.initials: F
authors.lastname: Tzortzatou-Stathopoulou
authors.forename: Maria A
authors.initials: MA
authors.lastname: Moschovi
authors.forename: Athina L
authors.initials: AL
authors.lastname: Papadopoulou
authors.forename: Ioanna G
authors.initials: IG
authors.lastname: Barbounaki
authors.forename: George I
authors.initials: GI
authors.lastname: Lambrou
authors.forename: Myrsini
authors.initials: M
authors.lastname: Balafouta
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Syriopoulou
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000633:toxicity; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome