[Significance of recurrence in children with acute lymphatic leukemia]

Abstract

Relapse is the main obstacle on the way to cure in children with acute lymphoblastic leukemia. In a retrospective study the influence of some prognostic factors and the prognosis have been evaluated in children with an isolated bone marrow relapse and an isolated CNS relapse. The median survival in 152 children with an isolated bone marrow relapse was 13.3 months. Favourable prognostic factors were: duration of first complete remission (CR) longer than 24 months, age at diagnosis between 2 and 6 years, initial leucocyte count below 50 X 10(9)/l, re-induction treatment with four drugs and the institution of a second central nervous system (CNS) prophylaxis. The most important prognostic factor was the duration of the first CR. The median survival in 140 children with a CNS relapse was 25 months. Favourable prognostic factors were: duration of first CR more than 24 months, age at diagnosis between 2 and 10 years, initial leucocyte count below 10 X 10(9)/l and a low blast count at the time of diagnosis of CNS relapse. The estimated survival in children with bone marrow relapse as well as in children with CNS relapse is less than 20%.

In conclusion: with current treatment regimens both bone marrow and CNS relapse have a very poor prognosis in children with acute lymphoblastic leukemia.