Acute lymphoblastic leukemia: A single center experience with Berlin, Frankfurt, and Munster-95 protocol

Radhakrishnan, Venkatraman; Gupta, Sumant; Ganesan, Prasanth; Rajendranath, Rejiv; Ganesan, Trivadi S.; Rajalekshmy, K. R.; Sagar, Tenali Gnana

doi:10.4103/0971-5851.171552

Cited by 24 publications

(17 citation statements)

References 12 publications

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“…The EFS from various Indian studies by Shanta et al, Radhakrishnan et al, and Advani et al ranged from 38% to 63.4% but was lower compared to global data in studies by Hunger et al, Chessells et al, and Pui et al, where the EFS ranged from 28% to 85.6% and OS ranged from 37% to 94%. [17][18][19][20][21][22] In our study for the entire group, the 3-year EFS and OS are 52% and 58%, respectively. The 3-year EFS and OS of B-ALL and T-ALL were not statistically different (59% vs. 45%, P = 0.18; 64% vs. 49%, P = 0.175).…”

Section: Discussionmentioning

confidence: 53%

Impact of cytogenetics on outcomes in pediatric acute lymphoblastic leukemia

Chennamaneni

Gundeti

Konatam

et al. 2018

South Asian J Cancer

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Context:In acute lymphoblastic leukemia (ALL), the most important prognostic factors are age, leukocyte count at presentation, immunophenotype, and cytogenetic abnormalities. The cytogenetic abnormalities are associated with distinct immunologic phenotypes of ALL and characteristic outcomes.Aims:The present study was primarily aimed at analyzing the impact of cytogenetics on postinduction responses and event-free survival (EFS) in pediatric patients with ALL. The secondary objective was to study the overall survival (OS).Subjects and Methods:A total of 240 patients with age <18 years and diagnosed with ALL between January 2011 and June 2016 were retrospectively analyzed. Cytogenetics was evaluated with conventional karyotyping or reverse transcriptase polymerase chain reaction. Based on cytogenetic abnormalities, the patients were grouped into five categories, and the outcomes were analyzed.Results:Of the 240 patients, 125 (52%) patients had evaluable cytogenetics. Of these, 77 (61.6%) patients had normal cytogenetics, 19 (15.2%) had t(9;22) translocation, 10 (8%) had unfavorable cytogenetics which included t(9;11), hypodiploidy, and complex karyotype, 10 (8%) had favorable cytogenetics which included t(12;21), t(1;19), and high hyperdiploidy, 9 (7.2%) had miscellaneous cytogenetics. Seventy-one percent of patients were treated with MCP 841 protocol, while 29% of patients received BFM-ALL 95 protocol. The 3-year EFS and OS of the entire group were 52% and 58%, respectively. On univariate analysis, EFS and OS were significantly lower in t(9;22) compared to normal cytogenetics (P = 0.033 and P = 0.0253, respectively) and were not significant for other subgroups compared to normal cytogenetics. On multivariate analysis, EFS was significantly lower for t(9;22) and unfavorable subgroups.Conclusions:Cytogenetics plays an important role in the molecular characterization of ALL defining the prognostic subgroups. Patients with unfavorable cytogenetics and with t(9;22) have poorer outcomes.

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Section: Discussionmentioning

confidence: 53%

Impact of cytogenetics on outcomes in pediatric acute lymphoblastic leukemia

Chennamaneni

Gundeti

Konatam

et al. 2018

South Asian J Cancer

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“…[10,13] More children presented with higher baseline WBC count (65% in our study) than average of 30%-40% in other studies. [10,14,15] We found higher proportions of BCR-ABL positivity (43% vs. 8.3% from a South Indian study). [16] We did not found any CNS-positive disease at baseline, as compared to 3%-6% positivity reported in various Indian studies.…”

Section: Discussionmentioning

confidence: 53%

Clinico-epidemiological features and response in childhood acute lymphoblastic leukemia at regional cancer center of Northeast India

Saikia

Roy

Kumar

et al. 2019

South Asian J Cancer

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Introduction:Acute lymphoblastic leukemia (ALL) comprises 19.3% of all childhood cancers in Northeast India.Methods:We analyzed clinicoepidemiological features and early response to the treatment of all the cases of childhood ALL (age <15 years) diagnosed and treated at Dr. B Borooah Cancer Institute over 1 year.Results:Of 52 eligible cases, 69% were male (male:female ratio of 2.2:1) and the mean age was 7.1 years. Thirty-three children (63%) had baseline white blood cell count ≥20 × 109/L. Precursor B-cell was most the common subtype seen in 61% of children. Seven cases (14%) had high-risk (HR) cytogenetics, with t (9,22) being the most common one. Male sex and HR cytogenetics were significantly associated with poor early responses.Conclusion:ALL is a common childhood malignancy with high cure rates. However, poor socioeconomic status and the presence of higher proportions of disease-related factors lead to poor outcome in this part of the country.

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“…Whereas the long-term survival reported from high-income countries for pediatric ALL is close to 90% 1 and for adult ALL is ~40%, 2 the corresponding survival is 60 and 22%, respectively, in studies from India. [3][4][5][6] The inferior outcomes in adults can be attributed mainly to adverse biologic features, along with the inability to tolerate chemotherapy, particularly in older adults. Some of the important factors for inferior outcomes in developing countries are delayed presentation, higher infections, poor social support system, inadequate treatment facilities, and treatment abandonment.…”

Section: Introductionmentioning

confidence: 99%

Chemotherapy Delays Are Associated with Inferior Outcome in Acute Lymphoblastic Leukemia: A Retrospective Study from a Tertiary Cancer Center in South India

Agrawal

Kayal

Ganesan

et al. 2021

Indian Journal of Medical and Paediatric Oncology

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Background Treatment protocols for acute lymphoblastic leukemia (ALL) have evolved over time to give excellent cure rates in children and moderate outcomes in adults; however, little is known how delays in chemotherapy affect long-term survival. Objectives To find the association of delays during different treatment phases on the survival outcomes. Materials and Methods Data from 149 ALL cases treated between 2009 and 2015 were retrospectively analyzed. Treatment course in commonly used protocols was divided into three phases—induction, consolidation (postremission), maintenance, and also a combined intensive phase (induction plus consolidation) for the purpose of analysis, and delay in each phase was defined based on clinically acceptable breaks. Analysis was done to find the impact of treatment delay in each phase on the survival outcomes. Results The median age was 12 years (range, 1–57). Multi-center Protocol-841 (MCP-841) was used for 72%, German Multicenter Study Group for Adult ALL (GMALL) for 19%, and Berlin, Frankfurt, Muenster, 95 protocol (BFM-95) for 9% of patients. Delay in induction was seen in 52%, consolidation in 66%, and during maintenance in 42% of patients. The median follow-up was 41 months, and 3-year survival outcomes for the entire cohort were event-free survival (EFS)—60%, relapse-free survival (RFS)—72%, and overall survival (OS)—68%. On univariate analysis, delay in induction adversely affected EFS (hazard ratio [HR] = 1.78, p = 0.04), while delay in intensive phase had significantly worse EFS and RFS (HR = 2.41 [p = 0.03] and HR = 2.57 [p = 0.03], respectively). On separate analysis of MCP-841 cohort, delay in intensive phase affected both EFS (HR = 3.85, p = 0.02) and RFS (HR = 3.42, p = 0.04), whereas delay in consolidation significantly affected OS with (HR = 4.74, p = 0.04) independently. Conclusion Treatment delays mostly in intensive phase are associated with worse survival in ALL; attempts should be made to maintain protocol-defined treatment intensity while adequately managing toxicities.

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Acute lymphoblastic leukemia: A single center experience with Berlin, Frankfurt, and Munster-95 protocol

Cited by 24 publications

References 12 publications

Impact of cytogenetics on outcomes in pediatric acute lymphoblastic leukemia

Impact of cytogenetics on outcomes in pediatric acute lymphoblastic leukemia

Clinico-epidemiological features and response in childhood acute lymphoblastic leukemia at regional cancer center of Northeast India

Chemotherapy Delays Are Associated with Inferior Outcome in Acute Lymphoblastic Leukemia: A Retrospective Study from a Tertiary Cancer Center in South India

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