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Treatment Outcomes in Children with High-Risk Acute Lymphoblastic Leukemia

Journal of the Korean Pediatric Society 1999;42(3):383-389.
Published online March 15, 1999.
Treatment Outcomes in Children with High-Risk Acute Lymphoblastic Leukemia
Kyu Chang Park, Ho Joon Im, Sang Yun Ahn, Hahng Lee
Department of Pediatrics, Hanyang University, College of Medicine, Seoul, Korea
소아 급성 림프구성 백혈병의 고위험군 치료성적 분석
박규창, 임호준, 안상윤, 이항
한양대학교 의과대학 소아과학교실
Abstract
Purpose
: The survival rate of those with acute lymphoblastic leukemia(ALL) has been affected by several prognostic factors and previous reports show that a 4-year event-free survival(EFS) for high-risk(HR) group(Age≥10 years and/or WBC≥50,000/mm3 at diagnosis) was approximately 64%. We analyzed treatment outcomes and risk factors in HR-ALL.
Methods
: Medical records of 27 patients with HR-ALL diagnosed between May, 1985 and December, 1996 were reviewed. HR-ALL was treated with a modified Children's Cancer Group (CCG)-Berlin-Frankfurt-Münster(BFM) chemotherapy regimen with an additional end-intensification at the completion of chemotherapy.
Results
: Of 27 patients, 17(63%) were aged over 10 years, 16(59%) had high leukocyte counts of ≥50,000/mm3, and 17(63%) had low platelet counts of <100,000/mm3 at diagnosis. As for the FAB classification, 16 had L1, and 11 had L2. As for the immunophenotypes, 20(74.1%) were B- lineage, and 7(25.9%) were T-lineage. The median follow-up was 39 months(2wks-12.3year). The 5-year EFS for total HR-ALL patients was 74.1%. The 5-year EFS was 81.3% for children with FAB L1 morphology, 63.6% for FAB L2, 85.7% for T-cell ALL, and 70.0% for B-precursor ALL. Of 27 patients, 25 achieved remission, with a remission induction rate of 92.6%. During the follow-up period after remission, three relapses and two deaths occurred.
Conclusion
: Conventional chemotherapy with additional end-intensification showed relatively good treatment outcome in HR-ALL with 5-year EFS of 74.1%, but larger studies of prognostic factors are needed.
Key Words: Acute Lymphoblastic Leukemia, High-Risk Group, Event Free Survival Rate, End-Intensification Therapy


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