title: First isolated extramedullary relapse in children with B-cell precursor acute lymphoblastic leukaemia: results of the Cooprall-97 study.
abstract: We report on the efficiency of treatment of first isolated extramedullary relapse of B-cell precursor acute lymphoblastic leukaemia. Sixty-eight children and adolescents were included in the trial COPRALL-97. Stratification criteria were time to relapse: first complete remission duration of less than 24 months for group G3A (n=35), relapse beyond 24 months for group G3B (n=33). Treatment consisted of risk-adapted alternating short course multiagent systemic and intrathecal chemotherapy and irradiation (18Gy). Event free survival (EFS) and overall survival (OS) for all registered patients at 6 years were 43% and 55%, respectively. EFS at 4 years for patients of group G3A and G3B were, respectively, 31% and 61% (p=0.0071) while OS at 4 years were, respectively, 40% and 76% (p=0.065). Our analyses highlighted two independent risks factors predictive of decreased EFS: early relapse and age at the initial diagnosis above 6 years. Early central nervous system relapses have a bad prognosis, and new therapeutic strategies are needed.
authors.affiliation: Service d'Immuno-Hématologie Pédiatrique, Institut d'Hématologie et Oncologie Pédiatrique, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Lyon Cedex 08, France. carine_halfon@yahoo.fr
authors.forename: Carine
authors.initials: C
authors.lastname: Domenech
authors.forename: Mariette
authors.initials: M
authors.lastname: Mercier
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Plouvier
authors.forename: Marc
authors.initials: M
authors.lastname: Puraveau
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordigoni
authors.forename: Gérard
authors.initials: G
authors.lastname: Michel
authors.forename: Yves
authors.initials: Y
authors.lastname: Benoit
authors.forename: Guy
authors.initials: G
authors.lastname: Leverger
authors.forename: André
authors.initials: A
authors.lastname: Baruchel
authors.forename: Yves
authors.initials: Y
authors.lastname: Bertrand
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D010051:Ovarian Neoplasms / Q000517:prevention & control; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D033581:Stem Cell Transplantation / Q000379:methods*; D013736:Testicular Neoplasms / Q000517:prevention & control; D016896:Treatment Outcome; D055815:Young Adult