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Original Article

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Korean J Hematol 2010; 45(2):

Published online June 30, 2010

https://doi.org/10.5045/kjh.2010.45.2.109

© The Korean Society of Hematology

Improved outcome in childhood ALL with intensive consolidation and hematopoietic stem cell transplant

Jeong A Park1, Thad Ghim2, Keun Wook Bae3, Kyung Nam Koh3, Ho Joon Im3, and Jong Jin Seo3*

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1Department of Pediatric, Inje University Haeundae Baik Hospital, Inje University College of Medicine, Busan, Korea.

2Department of Pediatrics, Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, USA.

3Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to : Correspondence to Jong Jin Seo, M.D., Ph.D. Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3383, Fax: +82-2-473-3725, jjseo@amc.seoul.kr

Received: March 12, 2010; Revised: June 16, 2010; Accepted: June 23, 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Background

Despite advances in chemotherapy, the prognosis of relapsed acute lymphoblastic leukemia (ALL) remains poor. Few studies on relapsed ALL have reported the importance of intensive consolidation followed with or without allogeneic hematopoietic stem cell transplantation (HSCT).

Methods

We evaluated the post-relapse outcomes in 47 Korean children with a first marrow relapse, and analyzed the prognostic factors.

Results

A second complete remission (CR) was achieved in 40 patients (85.1%), and at the time of this study, second CR was maintained in 12 of these patients. The estimated 3-yr event-free survival (EFS) rate after the first marrow relapse was 29.8±6.7%, and the overall survival (OS) rate was 45.3±7.5%. We found that second remission, consolidation of pediatric oncology group chemotherapy regimen (POG 9411), and HSCT significantly affected the outcome of the disease after relapse (P<0.001; P=0.004; P=0.05).

Conclusion

The results of our study revealed that an intensified POG 9411 consolidation chemotherapy regimen followed by HSCT can improve the outcome of patients with relapsed ALL.

Keywords Acute lymphoblastic leukemia, Relapse, Intensive consolidation, Hematopoietic stem cell transplantation

Article

Original Article

Korean J Hematol 2010; 45(2): 109-114

Published online June 30, 2010 https://doi.org/10.5045/kjh.2010.45.2.109

Copyright © The Korean Society of Hematology.

Improved outcome in childhood ALL with intensive consolidation and hematopoietic stem cell transplant

Jeong A Park1, Thad Ghim2, Keun Wook Bae3, Kyung Nam Koh3, Ho Joon Im3, and Jong Jin Seo3*

1Department of Pediatric, Inje University Haeundae Baik Hospital, Inje University College of Medicine, Busan, Korea.

2Department of Pediatrics, Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, USA.

3Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Correspondence to Jong Jin Seo, M.D., Ph.D. Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3383, Fax: +82-2-473-3725, jjseo@amc.seoul.kr

Received: March 12, 2010; Revised: June 16, 2010; Accepted: June 23, 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Despite advances in chemotherapy, the prognosis of relapsed acute lymphoblastic leukemia (ALL) remains poor. Few studies on relapsed ALL have reported the importance of intensive consolidation followed with or without allogeneic hematopoietic stem cell transplantation (HSCT).

Methods

We evaluated the post-relapse outcomes in 47 Korean children with a first marrow relapse, and analyzed the prognostic factors.

Results

A second complete remission (CR) was achieved in 40 patients (85.1%), and at the time of this study, second CR was maintained in 12 of these patients. The estimated 3-yr event-free survival (EFS) rate after the first marrow relapse was 29.8±6.7%, and the overall survival (OS) rate was 45.3±7.5%. We found that second remission, consolidation of pediatric oncology group chemotherapy regimen (POG 9411), and HSCT significantly affected the outcome of the disease after relapse (P<0.001; P=0.004; P=0.05).

Conclusion

The results of our study revealed that an intensified POG 9411 consolidation chemotherapy regimen followed by HSCT can improve the outcome of patients with relapsed ALL.

Keywords: Acute lymphoblastic leukemia, Relapse, Intensive consolidation, Hematopoietic stem cell transplantation

Fig 1.

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Figure 1.

Treatment overview and outcomes for patients with marrow-relapse ALL.

Blood Research 2010; 45: 109-114https://doi.org/10.5045/kjh.2010.45.2.109

Fig 2.

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Figure 2.

Event-free survival rates and overall survival rates of patients with marrow-relapse ALL. Event-free survival rates differed due to the achievement of second remission (A), consolidation chemotherapy after remission (B), and allogeneic hematopoeitic stem call transplantation (HSCT) (C). Overall survival rates were significantly affected by the achievement of second remission (D).

Blood Research 2010; 45: 109-114https://doi.org/10.5045/kjh.2010.45.2.109

Table 1 . POG 9411 treatment schedule..

a)We substituted PEG to E-coli L-asparaginase due to Korean medical insurance problem. If cumulative dose of anthracylines ≥ 450 mg/m2, b)substitute PEG 2,500 IU/m2/day IM at day 1 and 8 or E-coli L-asparaginase 10,000 IU/m2 IM days 1, 3, 5, 8, 10, 12, 15 and 17, or c)discontinue idarubicin..

Table 2 . ALL 0603 Induction for marrow relapsed ALL..

Abbreviation: ANC, absolute neutrophil count..

Table 3 . Clinical characteristics of patients..

Abbreviation: NCI, national cancer institute..

Table 4 . Chemotherapies for marrow relapsed patients..


Table 5 . Prognostic factors after marrow relapse..

Abbreviations: CI, confidence interval; NCI, national cancer institute; HSCT, hematopoietic stem cell transplantation..
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