Improved outcome for acute lymphoblastic leukemia in children of a developing country: Results of the Chilean national trial PINDA 87

Abstract

Background The National Chilean Pediatric Oncology Group, PINDA, reports the first prospective, nonrandomized trial for acute lymphoblastic leukemia (ALL), using a modified version of the Berlin‐Frankfurt‐Munster protocol (ALL BFM 86). The aim of this study was to classify immunophenotypes, to decrease cranial irradiation, and to assess whether this protocol would improve the survival rate. Procedure From June, 1987, to June, 1992, 444 unselected children were diagnosed with ALL. Of them, 425 were evaluable. Therapy was stratified by risk. Standard‐risk (SR) and high‐risk (HR) patients received protocols I, M, II, and maintenance therapy. Very‐high‐risk (VHR) patients received protocol E instead of protocol M. All patients received a prephase treatment consisting of prednisone and intrathecal methotrexate (MTX). HR and VHR patients received cranial irradiation (12–18 Gy). The following changes were made to the ALL BFM 86 protocol: in protocol M, MTX 1 g/m2 instead of 5 g/m2; in protocol E, citarabine 1 g/m2 instead of 2 g/m2; mithoxantrone and ifosfamide were substituted by teniposide and cyclophosphamide. Results Immunophenotypes: pro‐B‐ALL, 14%; common ALL, 67.4%; pre‐B‐ALL, 4.3%; T‐ALL, 10%; undifferentiated leukemia (AUL), 4.3%. The overall 5‐year event‐free survival (EFS) rate was 60% ± 2% (SE). The 5‐year EFS rate for each risk group was: SR 75%, HR 62%, VHR 28%, with a median follow‐up of 6.5 years (range 4.5–9.5 years). The cumulative incidence of central nervous system (CNS) relapse was 5.4%. Conclusions We have been able successfully to perform a nationwide study. Our strategy to adapt the BFM protocol to our population of patients trial was effective in improving the EFS. The immunophenotype distribution is similar to that in other reported series. Med. Pediatr. Oncol. 33:88–94, 1999. © 1999 Wiley‐Liss, Inc.

Implementation of an intensive risk‐stratified treatment protocol for children and adolescents with acute lymphoblastic leukemia in Lebanon

“…However, 80-85% of the cases of childhood ALL occur in resource-poor countries where the cure rate is significantly lower than that of resource-rich countries. The prognosis of childhood ALL is poor in these countries due to several clinical, social, and environmental factors [9][10][11]18].…”

“…In low-income countries (LICs), however, therapy results for pediatric ALL are still not encouraging. Cure rates are lower due to relapse, abandonment of therapy, and death from toxicity secondary to suboptimal supportive care, delayed diagnosis, and comorbid conditions [9][10][11]. In Lebanon, only one study presented pediatric ALL experience and survival results [12].…”

Survival and prognostic factors of childhood acute lymphoblastic leukemia

“…7,17 The survival-rate of childhood ALL in this study was lower than in other studies. 1,8,11,[20][21] High death-rate during induction phase and high relapserate influenced the low survival in this study. The more tolerable chemotherapy protocol during induction phase and during CNS prophylaxis, the higher the relapse-rate.…”

“…Remission rate in this study was lower than remission rate in other studies which could reach up to 98%. 8,1 protocol of which has become more tolerable, could lead to lower remission rate in this study. High death-ra could also be the cause of the low remission rate.…”

“…Relapse occurred in 48 subjects with median time was 13 months. Relapse locations were; bone marrow (39), CNS (4), bone marrow and CNS (3), testicle (1), bone marrow and testicle (1). The duration of continuous complete remission ranged from 2 months to 101 months (median was 25 months).…”