Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Educational Letter
  • Published:

Acute Leukemias

Long-term results of treatment of childhood acute lymphoblastic leukemia in the Czech Republic

Leukemia volume 24, pages 425–428 (2010)Cite this article

Treatment of children with acute lymphoblastic leukemia (ALL) in the Czech Republic was unified during the second half of the 1980s through the gradual introduction of protocol ALL-BFM 83 at the individual departments of pediatrics of regional and/or teaching hospitals (eight centers overall, five of which are affiliated to a medical school). During that period, the Working Group for Pediatric Hematology in the Czech Republic (CPH) was established, and recommendations for uniform diagnostic approaches for pediatric ALL were developed. ALL-BFM 90 therapy was used by all eight centers over a period spanning from 1990 to 1996 and data were collected in a central site. All patients enrolled into the study had immunophenotyping and cytogenetics performed at selected centers with better equipment and experience, whereas screening for BCR/ABL and MLL/AF4 by PCR was carried out at a single national reference laboratory. Patients were stratified into three risk groups according to the original criteria of ALL-BFM 90; however, they were not randomized using the corresponding standard therapeutic arms of the study.1, 2 The use of high-dose methotrexate (5 g/m2) was introduced at the individual centers gradually during the study, and prophylactic cranial radiotherapy at 12 Gy was applied in children with medium- and high-risk disease. Study ALL-BFM 95 was conducted from 1996 to 2002, with a central review of morphology at initial diagnosis and at relapse, screening of all patients for BCR/ABL, MLL/AF4 and TEL/AML1 gene rearrangements by PCR at one reference molecular biology laboratory and immunophenotyping of all cases at one central reference flow cytometry laboratory. Risk-group stratification of patients was performed as stipulated by the original German–Austrian–Swiss study.3 In this trial too, treatment was given according to the corresponding standard arms, and prophylactic cranial radiotherapy at 12 Gy was reserved only for children with T-ALL or high-risk disease. Medium-risk patients were randomized within the I-BFM-SG trial to receive either conventional maintenance treatment with daily 6-mercaptopurine and weekly methotrexate, or pulses of dexamethasone and vincristine, in addition to conventional oral therapy.4 Infants younger than 1 year were managed according to protocol POG 9407 (n=5) or Interfant 99 (n=13). Cranial radiotherapy was omitted for all infants <1 year of age. Event-free survival (EFS) was defined as the time from diagnosis until induction failure, relapse, death from any cause or second cancer. Patients surviving event free were censored at date of last follow-up. Cases that did not achieve complete remission were considered failures at time zero. EFS and overall survival (OS) were estimated by Kaplan–Meier life-table analysis, and the log-rank test was used to assess differences in survival. Univariate analysis was used to identify prognostic factors for EFS and OS, whereby a P-value <0.05 was considered significant. For patients who attained complete remission, the cumulative incidence functions of isolated or any central nervous system (CNS) relapse, as well as the cumulative incidence functions of developing a therapy-related second malignancy, were drawn by the method of Kalbfleisch and Prentice.

The outstanding collaboration at a national level in the 1990s has paved the way for the active role of CPH in ALL IC-BFM 2002, the I-BFM-SG international randomized trial for treatment of children and adolescents with non-B ALL, which was run from 2002 to 2007.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

References

  1. Schrappe M, Reiter A, Ludwig WD, Harbott J, Zimmermann M, Hiddemann W et al. Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: results of trial ALL-BFM 90. German-Austrian-Swiss ALL Study Group. Blood 2000; 95: 3310–3322.

    CAS  PubMed  Google Scholar 

  2. Stary J, Gajdos P, Hrstkova H, Blazek B, Slavik Z, Mihal V et al. Treatment of Czech children with acute lymphoblastic leukemia: a report of the Czech Working Group for Pediatric Hematology. Med Pediatr Oncol 2002; 39: 125–127.

    Article  Google Scholar 

  3. Möricke A, Reiter A, Zimmermann M, Gadner H, Stanulla M, Dördelmann M, et al. German-Austrian-Swiss ALL Study Group. Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patiens enrolled in the trial ALL-BFM 95. Blood 2008; 111: 4477–4489.

    Article  Google Scholar 

  4. Conter V, Valsecchi MG, Silvestri D, Campbell M, Dibar E, Magyarosy E et al. Pulses of vincristine and dexamethasone in addition to intensive chemotherapy for children with intermediate-risk acute lymphoblastic leukaemia: a multicentre randomised trial. Lancet 2007; 369: 123–131.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the patients and families who participated in the trials, the physicians and nurses of all hospitals, and cytomorphologists and cytogeneticists for their input in performing the studies. We also thank I Janotova for data management. This study was supported in part by the Czech Ministry of Education (MSM0021620813).

Author information

Authors and Affiliations

  1. Department of Pediatric Hematology/Oncology, University Hospital Motol and 2nd Medical School, Charles’ University, Praha, Czech Republic

    J Stary, J Trka, O Hrusak, P Gajdos, P Smisek, P Sedlacek, V Vavra & O Hrodek

  2. Department of Pediatrics, Regional Hospital, Ceske Budejovice, Czech Republic

    Y Jabali

  3. Department of Pediatrics, University Hospital Brno, Brno, Czech Republic

    H Hrstkova

  4. Children's Hospital, Masaryk's University, Brno, Czech Republic

    H Hrstkova & J Sterba

  5. Department of Pediatric Oncology, University Hospital Brno, Brno, Czech Republic

    J Sterba

  6. Department of Pediatric and Adolescent Medicine, Teaching Hospital, Ostrava, Czech Republic

    B Blazek

  7. Department of Pediatrics, Teaching Hospital, Hradec Kralove, Czech Republic

    J Hak

  8. Department of Pediatrics, Masaryk's Hospital, Usti nad Labem, Czech Republic

    D Prochazkova

  9. Department of Pediatrics, Teaching Hospital affiliated to Charles’ University, Plzen, Czech Republic

    Z Cerna

  10. Department of Pediatrics, University Hospital, Palacky's University, Olomouc, Czech Republic

    V Mihal

Authors
  1. J Stary
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y Jabali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Trka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O Hrusak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P Gajdos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H Hrstkova
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J Sterba
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. B Blazek
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J Hak
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. D Prochazkova
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Z Cerna
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. P Smisek
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. P Sedlacek
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. V Vavra
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. V Mihal
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. O Hrodek
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of Czech Pediatric Hematology working group

Corresponding author

Correspondence to J Stary.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stary, J., Jabali, Y., Trka, J. et al. Long-term results of treatment of childhood acute lymphoblastic leukemia in the Czech Republic. Leukemia 24, 425–428 (2010). https://doi.org/10.1038/leu.2009.255

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/leu.2009.255

This article is cited by

Search

Advanced search

Quick links