Original Article

Korean J Hematol 2008; 43(4):

Published online December 31, 2008

https://doi.org/10.5045/kjh.2008.43.4.238

© The Korean Society of Hematology

고위험군 소아 급성림프모구백혈병에서 초기 반응에 따른 치료 변경의 효과

윤종형 김은경 박정아 강형진 신희영 안효섭

서울대학교 의과대학 소아과학교실, 암연구소

Effect of Treatment Modification by Initial Response in High-Risk Childhood Acute Lymphoblastic Leukemia

Jong Hyung Yoon, Eun Kyung Kim, Jeong Ah Park, Hyoung Jin Kang, Hee Young Shin, Hyo Seop Ahn

Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

Abstract

Background: Bone marrow (BM) finding on day 7 of induction chemotherapy is one of major prognostic factors in acute lymphoblastic leukemia (ALL). M3 marrow (blast >25% on BM examination) on day 7 is associated with lower survival rates, compared with M1 (blast <5%) or M2 (blast 5∼25%) marrow. Herein, we analyzed the effect of the augmented post-induction chemotherapy in patients with high-risk ALL with M3 marrow on day 7 BM examination. Methods: Patients diagnosed as high-risk ALL and received modified Children's Cancer Group (CCG)- 1882 induction chemotherapy between January 1996 and October 2005 at Seoul National University Children's Hospital were analyzed. Patients with M1 or M2 marrow on day 7 were treated with modified CCG-1882A/B chemotherapy from consolidation and patients with M3 marrow were treated with modified CCG-1882C chemotherapy. Results: Total 44 patients (29 with modified CCG-1882A/B and 15 with modified CCG-1882C) were analyzed. The overall survival (OS) and 5-year event-free survival (EFS) were 86.2% and 81.9%, respectively. The OS of the patients who were treated with modified CCG-1882A/B protocol (88.9%) was not different from that of the patients with modified CCG-1882C protocol (80.0%) (P=0.3256). Also, there was no statistical difference in 5-year EFS of both groups (85.4% vs 72.7%, P=0.2117). Conclusions: There was no difference between survival of the patients with M1/M2 marrow on day 7 BM examination and M3 marrow after augmented post-induction chemotherapy in patient with high-risk ALL. We suggest that poor prognosis of high-risk ALL with poor initial response could be overcome by augmented post-induction chemotherapy. (Korean J Hematol 2008;43:238-246.)

Keywords High-risk acute lymphoblastic leukemia, Augmented post-induction chemotherapy, Childhood, Response, Prognosis, Survival rate

Article

Original Article

Korean J Hematol 2008; 43(4): 238-246

Published online December 31, 2008 https://doi.org/10.5045/kjh.2008.43.4.238

Copyright © The Korean Society of Hematology.

고위험군 소아 급성림프모구백혈병에서 초기 반응에 따른 치료 변경의 효과

윤종형 김은경 박정아 강형진 신희영 안효섭

서울대학교 의과대학 소아과학교실, 암연구소

Effect of Treatment Modification by Initial Response in High-Risk Childhood Acute Lymphoblastic Leukemia

Jong Hyung Yoon, Eun Kyung Kim, Jeong Ah Park, Hyoung Jin Kang, Hee Young Shin, Hyo Seop Ahn

Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

Abstract

Background: Bone marrow (BM) finding on day 7 of induction chemotherapy is one of major prognostic factors in acute lymphoblastic leukemia (ALL). M3 marrow (blast >25% on BM examination) on day 7 is associated with lower survival rates, compared with M1 (blast <5%) or M2 (blast 5∼25%) marrow. Herein, we analyzed the effect of the augmented post-induction chemotherapy in patients with high-risk ALL with M3 marrow on day 7 BM examination. Methods: Patients diagnosed as high-risk ALL and received modified Children's Cancer Group (CCG)- 1882 induction chemotherapy between January 1996 and October 2005 at Seoul National University Children's Hospital were analyzed. Patients with M1 or M2 marrow on day 7 were treated with modified CCG-1882A/B chemotherapy from consolidation and patients with M3 marrow were treated with modified CCG-1882C chemotherapy. Results: Total 44 patients (29 with modified CCG-1882A/B and 15 with modified CCG-1882C) were analyzed. The overall survival (OS) and 5-year event-free survival (EFS) were 86.2% and 81.9%, respectively. The OS of the patients who were treated with modified CCG-1882A/B protocol (88.9%) was not different from that of the patients with modified CCG-1882C protocol (80.0%) (P=0.3256). Also, there was no statistical difference in 5-year EFS of both groups (85.4% vs 72.7%, P=0.2117). Conclusions: There was no difference between survival of the patients with M1/M2 marrow on day 7 BM examination and M3 marrow after augmented post-induction chemotherapy in patient with high-risk ALL. We suggest that poor prognosis of high-risk ALL with poor initial response could be overcome by augmented post-induction chemotherapy. (Korean J Hematol 2008;43:238-246.)

Keywords: High-risk acute lymphoblastic leukemia, Augmented post-induction chemotherapy, Childhood, Response, Prognosis, Survival rate

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