hematology
Contributions
Type: Publication Only
Background
Childhood acute lymphoblastic leukemia (ALL) is an hematologic malignancies with high rate of cure. We report the experience of the department of clinical hematology of Sfax for the treatment of childhood ALL with the EORTC 58951 protocol.
Aims
we report the results of fourteen years treatment of childhood acute lymphoblastic leukemia with the EORTC 58951 Protocol
Methods
From January 2000 to December 2013, we retrospectively studied the outcome of all childhood ALL treated with the EORTC 58951 pediatric protocol. For those patients we studied the leukemia characteristics (sex ratio, white blood cell counts WBC, blast’s phenotype, cytogenetic abnormalities) and response to treatment: response to prophase, remission rate, risk group stratification, treatment related mortality (TRM) (induction and post induction death) and survival (overall survival OS, event free survival EFS and disease free survival DFS: calculated for patients in complete remission). We complete the analysis by a comparison between two periods P1 and P2 (P1: 2000-2006 and P2: 2007-2013).
Results
From January 2000 to December 2013, 160 children were treated with the EORTC 58951 protocol. Median age was 6 years (range: 13 months to 15 years). Sex ratio M/F was 1.4. WBC counts less than 10 G/l, from 10 to 100 G/L and more than 100 G/L were observed respectively in 42, 42 and 16% of cases. The blast’s phenotype was B in 70% and T in 30%. Cytogenetic abnormalities were noted in 48% of cases. A good response to prophase was noted in 84% and complete remission in 97% of cases. The EORTC risk group stratification was Low Risk (LR) in 6.5%, Average Risk1 (AR1) in 45%, Average Risk2 (AR2) in 25.5% and Very High Risk (VHR) in 23%. TRM was 9%: induction rate death was 7% and post-induction rate death was 2%. Seven patients from VHR group with familial donor underwent allograft. The relapse rate was 23% of all patients in remission; 10% for LR group, 22% for AR1 group, 17% for AR2 group and 37.5% for VHR group. At 5 years of follow up, OS, EFS and DFS were 67, 64 and 74% respectively. We compared two periods, we noted less TRM and less relapse in P2 with respectively (2% vs 14%) and (19% vs 28%), so we have a good survival at 5 years in P2 (OS: 75% vs 58%, EFS: 73% vs 55% DFS: 79% vs 68%).
Summary
Childhood ALL in our institut were characterized by a poor presentation at diagnosis: male sex, leucocytosis more than 100 G/L, T phenotype and bad response to prophase are frequent compared to the occident reports. EFS are acceptable in our study but still less than observed in literature (85-90%). We have noted an improvement in the survival rates during the second period P2 this could be explained by improved support treatment
Keyword(s): Acute lymphoblastic leukemia
Session topic: Publication Only
Type: Publication Only
Background
Childhood acute lymphoblastic leukemia (ALL) is an hematologic malignancies with high rate of cure. We report the experience of the department of clinical hematology of Sfax for the treatment of childhood ALL with the EORTC 58951 protocol.
Aims
we report the results of fourteen years treatment of childhood acute lymphoblastic leukemia with the EORTC 58951 Protocol
Methods
From January 2000 to December 2013, we retrospectively studied the outcome of all childhood ALL treated with the EORTC 58951 pediatric protocol. For those patients we studied the leukemia characteristics (sex ratio, white blood cell counts WBC, blast’s phenotype, cytogenetic abnormalities) and response to treatment: response to prophase, remission rate, risk group stratification, treatment related mortality (TRM) (induction and post induction death) and survival (overall survival OS, event free survival EFS and disease free survival DFS: calculated for patients in complete remission). We complete the analysis by a comparison between two periods P1 and P2 (P1: 2000-2006 and P2: 2007-2013).
Results
From January 2000 to December 2013, 160 children were treated with the EORTC 58951 protocol. Median age was 6 years (range: 13 months to 15 years). Sex ratio M/F was 1.4. WBC counts less than 10 G/l, from 10 to 100 G/L and more than 100 G/L were observed respectively in 42, 42 and 16% of cases. The blast’s phenotype was B in 70% and T in 30%. Cytogenetic abnormalities were noted in 48% of cases. A good response to prophase was noted in 84% and complete remission in 97% of cases. The EORTC risk group stratification was Low Risk (LR) in 6.5%, Average Risk1 (AR1) in 45%, Average Risk2 (AR2) in 25.5% and Very High Risk (VHR) in 23%. TRM was 9%: induction rate death was 7% and post-induction rate death was 2%. Seven patients from VHR group with familial donor underwent allograft. The relapse rate was 23% of all patients in remission; 10% for LR group, 22% for AR1 group, 17% for AR2 group and 37.5% for VHR group. At 5 years of follow up, OS, EFS and DFS were 67, 64 and 74% respectively. We compared two periods, we noted less TRM and less relapse in P2 with respectively (2% vs 14%) and (19% vs 28%), so we have a good survival at 5 years in P2 (OS: 75% vs 58%, EFS: 73% vs 55% DFS: 79% vs 68%).
Summary
Childhood ALL in our institut were characterized by a poor presentation at diagnosis: male sex, leucocytosis more than 100 G/L, T phenotype and bad response to prophase are frequent compared to the occident reports. EFS are acceptable in our study but still less than observed in literature (85-90%). We have noted an improvement in the survival rates during the second period P2 this could be explained by improved support treatment
Keyword(s): Acute lymphoblastic leukemia
Session topic: Publication Only