A Multicenter Retrospective Analysis on the Treatment Pattern and Outcome in Relapsed/Refractory Childhood Acute Lymphoblastic Leukemia
10.15264/cpho.2017.24.2.101
- Author:
Keon Hee YOO
1
;
Nak Gyun CHUNG
;
Bin CHO
;
Hyoung Jin KANG
;
Hee Young SHIN
;
Ho Joon IM
;
Jong Jin SEO
;
Young Tak LIM
;
Chuhl Joo LYU
;
Soon Ki KIM
;
In Sang JEON
;
Hoon KOOK
;
Hong Hoe KOO
Author Information
1. Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. hhkoo@skku.edu
- Publication Type:Multicenter Study
- Keywords:
Childhood;
Acute lymphoblastic leukemia;
Relapsed;
Refractory
- MeSH:
Blood Platelets;
Cytarabine;
Diagnosis;
Hematopoietic Stem Cell Transplantation;
Humans;
Idarubicin;
Precursor Cell Lymphoblastic Leukemia-Lymphoma;
Prognosis;
Retrospective Studies;
Vincristine
- From:Clinical Pediatric Hematology-Oncology
2017;24(2):101-106
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Although the overall survival of childhood acute lymphoblastic leukemia (ALL) approaches 85-90%, the prognosis of relapsed or refractory (R/R) ALL is grave. This study aimed to identify the treatment pattern, treatment response, and overall survival of these patients.METHODS: We reviewed data of 64 patients with R/R ALL whose initial diagnosis of ALL had been made between 1 and 21 years of age. Patients who received clofarabine as part of an induction regimen were excluded. Relapsed patients were limited to those who relapsed after ≥2 prior induction regimens. Treatment patterns, response rates, and overall survival were analyzed.RESULTS: Patients' median age was 15.0 years (range, 6.0-25.0) at the diagnosis of R/R ALL. The most frequently used agents other than steroid were vincristine (54.0%), cytarabine (44.6%), and idarubicin (36.5%), while L-asparaginase was used in only one patient. The complete remission (CR) and overall response (OR) rates were 38.1 and 42.9%, respectively. Sixteen patients (25.4%) underwent allogeneic hematopoietic stem cell transplantation (HSCT). The 5-year overall survival was 6.7%. The survival of patients with HSCT was significantly higher compared with those without HSCT (35.2% vs 0%, P=0.0097). Among 14 patients who achieved CR or CR without platelet recovery (CRp) before HSCT, the 3-year survival was 46.9%.CONCLUSION: The survival of Korean patients with R/R childhood ALL was dismal despite a reasonable CR rate, whereas that of those who received HSCT after CR or CRp was excellent. More treatment options are needed to improve the overall outcome of R/R childhood ALL.
