Abstract
Determination of the optimal duration of therapy and identification of patients (pts) at risk of relapsing after therapy is discontinuea are important strategies in ALL now that ≥50% of effectively-treated children are ≥3 year disease free sur vivqrs (DFS). Approximately 10-20% of pts sustain LR. Two CCSG studies, COG 141 and CCG 160 series were designed to evaluate the significance of clinical and biologic prognostic factors in determining outcome. In CCG 141, the early response to induction therapy as determined by the percentage orblasts in the day 14 bone marrow (dI4BM) aspirate is a highly significant, independent predictor of DPS. In addition the overall relapse rate, isolated BM relapse rate and death rate were significantly higher in pts with OTL (N=23, 9.7%) detected after 3 years DPS than in pts with negative biopsies (bx) (N=206, 86.9%), p<0.001. DFS after testicular bx was significantly better in pts without OTL (p.0.005). BM relapse and death rates were significantly higher in pts with OTL than in boys (N=26, 9.9%) who did not undergo bx. In a subsequent trial, CCG 160 series, of 1490 pts with complete data, dl4BM ranked 6th (p<0.001) by univariate analysis and 4th (p<0.001) by multivariate analysis as a predictor of DFS. CCG 160 pts were randomized after 2 yrs of DFS to receive 2 or 3 yrs of maintenance therapy. The dl4BM was the most significant predictor of DFS after late randomization, The observed/expected (O/E) failure rate in pts with dl4 M1 (<5% blasts), M2(5-25%), or M3(>25%) BM ratings was 0.88, 1.78 and 2.02 respectively, (p0.0002). Other significant predictors of LR wer group (p0.0003) and initial WBC (p0.004). In conclusion, early response should be monitored closely and alternate induction regimens used for slow responders. At end therapy, the presence of OTL indicates significant, aggressive minimal residual disease requiring intervention and intensification of therapy.
Article PDF
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Miller, D., Leikin, S., Albo, V. et al. EARLY RESPONSE TO INDUCTION THERAPY AND OCCULT TESTICULAR LEUKEMIA (OTL) AT END THERAPY PREDICT LATE RELAPSE (LR) IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA (ALL). Pediatr Res 21 (Suppl 4), 302 (1987). https://doi.org/10.1203/00006450-198704010-00808
Issue Date:
DOI: https://doi.org/10.1203/00006450-198704010-00808