title: Pattern of relapse in childhood ALL: challenges and lessons from a uniform treatment protocol.
abstract: This retrospective analysis of 254 children less than 15 years of age treated with MCP-841 protocol from June 1992 to June 2002 was undertaken to identify the pattern of relapse and determine management lacunae. Two hundred twenty-three (87.8%) children achieved a complete remission of whom 40 (17.9%) relapsed. The mean age of relapsed patients was 6.5 years. The male/female ratio was 9:1. There were 23 (57.5%) isolated bone marrow (BM), 7 (17.5%) isolated central nervous system (CNS), 2 (5%) isolated testicular, 5 (12.5%) BM+testes and 1 each of BM+CNS, CNS+testes, and isolated bone relapses. Twenty-seven children (67.5%) relapsed on-therapy whereas 13 (32.5%) relapsed posttherapy. All 9 CNS relapses occurred on-therapy whereas 5/8 (62.5%) of testicular relapses occurred posttherapy. Lymphadenopathy was the only significant predictor for relapse. High-risk features such as age less than 1 year and greater than 10 years (P=0.047) and white cell count greater than 50.0 x 10(9)/L (P=0.044) were significantly more frequent in patients with early on-therapy relapse than in patients with off-therapy relapse. The overall survival in the entire study cohort was 67+/-3.5%. Modest survival outcome, relapse while on chemotherapy and the higher incidence of CNS and testicular relapse indicate the need for reappraisal of our treatment protocol. There is a need of identifying risk factors and high-risk groups in our set of patients and risk-stratified intensification of chemotherapy in them.
authors.affiliation: Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. lsarya@rediffmail.com
authors.forename: Laxman Singh
authors.initials: LS
authors.lastname: Arya
authors.forename: S P
authors.initials: SP
authors.lastname: Kotikanyadanam
authors.forename: Manorama
authors.initials: M
authors.lastname: Bhargava
authors.forename: Renu
authors.initials: R
authors.lastname: Saxena
authors.forename: Sudha
authors.initials: S
authors.lastname: Sazawal
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
authors.forename: Anshu
authors.initials: A
authors.lastname: Khattar
authors.forename: Ketan P
authors.initials: KP
authors.lastname: Kulkarni
authors.forename: Melissa
authors.initials: M
authors.lastname: Adde
authors.forename: Trib S
authors.initials: TS
authors.lastname: Vats
authors.forename: Ian
authors.initials: I
authors.lastname: Magrath
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D019046:Bone Marrow Neoplasms / Q000401:mortality / Q000628:therapy*; D001932:Brain Neoplasms / Q000401:mortality* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000628:therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome