[Analysis of therapy results and prognostic factors in children with acute lymphoblastic leukaemia in Warmia and Mazury region: 17-years experience].
In the Warmia and Mazury region inhabited by 1.4 mln people, 6-16 new cases od childhood acute leukaemia are reported every year.


OBJECTIVE
Analysis of treatment outcome and identification of prognostic factors in children treated for acute lymphoblastic leukaemia (ALL).


METHODS
A total number of 113 children aged 1.1-17.8 years (median age 5.5 years) were diagnosed for ALL in the Specialist Children Hospital of Olsztyn Province between 1991-2007. Children were treated in 6 consecutive protocols including 4 of the BFM group (Berlin-Frankfurt-Münster) and 2 of the modified American New York and New York II protocols. Probability of event-free survival (pEFS) was the principal indicator of effective of treatment in ALL.


RESULTS
Kaplan-Meier estimate of 17-year pEFS of all the 113 study patients was 0.72+/-0.05. The analysis of treatment results showed gradual improvement in the consecutive treatment protocols, including: pEFS=0.61+/-0.15 in the New York protocol; in the New York II - pEFS=0.76+/-0.15; in ALL-BFM-86 - pEFS=0,71+/-0,10; in ALL-BFM-90 - pEFS=0.79+/-0.08; in ALL-BFM-95 - pEFS=0.72+/-0.11. The protocol ALL-IC-2002 is ongoing. Prognostic factors for pEFS by univariate analysis were: male gender (p=0.003), age under 2 year (p=0.004), spleen enlargement (p=0.043), Hgb>10g/dl (p=0.025), WBC>100 G/L (p=0.007), FAB L2 (p<0.001), loss of weight p=0.022 and defects of eyesight (p=0.006) before the diagnosis of ALL, and HBV infection during the therapy (p=0.019). Independent risk factors by multivariate analysis were: male gender (p=0.005), age under 2 year (p=0.052), the spleen enlargement (p=0.028), WBC>100 G/L (p=0.007), FAB L2 (p=0.007), eyesight defects (p=0.009) before the diagnosis of ALL, and infection of HBV during the therapy (p=0.027).


CONCLUSIONS
Large progress has been made in the treatment of acute lymphoblastic leukaemia of childhood and adolescence over the analyzed period of 17 years. Treatment results for children with acute lymphoblastic leukaemia in Olsztyn Province are similar to the results in the Polish Paediatric Leukaemia/Lymphoma Study Group.
Badowska
Wanda
W
Wojewódzki Specjalistyczny Szpital Dzieciecy, Oddział Pediatryczny i Hematologiczno-Onkologiczny, ul. zołnierska 18, 10-561 Olsztyn, Poland. hematologia@wssd.olsztyn.pl
D000293:Adolescent; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001215:Asparaginase / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D003630:Daunorubicin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D011044:Poland / Q000453:epidemiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000453:epidemiology; D011241:Prednisone / Q000627:therapeutic use; D015995:Prevalence; D011379:Prognosis; D012737:Sex Factors; D013866:Thioguanine / Q000627:therapeutic use; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
D003561:Cytarabine; D014750:Vincristine; D003520:Cyclophosphamide; D001215:Asparaginase; D013866:Thioguanine; D011241:Prednisone; D008727:Methotrexate; D003630:Daunorubicin