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Acute Lymphocytic Leukemia

Overt testicular disease at diagnosis of childhood acute lymphoblastic leukemia: lack of therapeutic role of local irradiation

Abstract

To assess the prognosis of overt testicular disease at diagnosis of acute lymphoblastic leukemia, and any therapeutic role of irradiation for this involvement, we reviewed the data of 811 boys treated on St Jude studies Total X–XI (early period) and Total XII-XIV (recent period). In all, 19 boys (2.3%) had testicular disease at diagnosis. In the early period, patients with testicular leukemia had a poorer overall survival (OS) (P=0.003), event-free survival (EFS) (P=0.064), and higher cumulative incidence of relapse (P=0.041) than did other patients. During the recent period, patients with and without overt testicular leukemia did not differ in OS (P=0.257), EFS (P=0.102), or cumulative incidence of relapse (P=0.51). In a multivariate analysis, OS was lower for patients with testicular disease than for those without the involvement in the early period (P=0.047) but not in the recent one (P=0.75). Both patients who received irradiation for residual testicular disease at the end of induction subsequently died of leukemia. Of the other 17 patients who did not receive irradiation, only one developed testicular relapse in combination with bone marrow relapse. In conclusion, the prognostic impact of overt testicular disease has diminished. Irradiation appears to provide no survival advantage to this patient population.

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Acknowledgements

We thank Julia Cay Jones, PhD, for her expert editorial review; James Boyett, PhD, and Deo Kumar Srivastava, PhD, for helpful suggestions concerning the statistical analysis; Imella Smith Herrington for her assistance in manuscript preparation; Jeana Cromer for her administrative assistance; and Annette Stone and Gena Durham for data collection. This work was supported in part by a Cancer Center Support Grant (CA21765) from the National Cancer Institute and by the American Lebanese Syrian Associated Charities (ALSAC). Ching-Hon Pui is the American Cancer Society FM Kirby Clinical Research Professor.

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Correspondence to N Hijiya.

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Hijiya, N., Liu, W., Sandlund, J. et al. Overt testicular disease at diagnosis of childhood acute lymphoblastic leukemia: lack of therapeutic role of local irradiation. Leukemia 19, 1399–1403 (2005). https://doi.org/10.1038/sj.leu.2403843

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