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Third consecutive national study ALL-BFM 95 improved the outcome of acute lymphoblastic leukemia in children in the Czech Republic


Authors: J. Starý 1;  P. Gajdoš 1;  H. Hrstková 2;  L. Kopečná 2;  J. Štěrba 3;  D. Dembická 3;  D. Mendelová 3;  D. Pospíšilová 4;  M. Hajdúch 4;  B. Blažek 5;  H. Ptoszková 5;  J. Hak 6;  K. Toušovská 6;  D. Procházková 7;  Z. Černá 8;  Y. Jabali 9;  P. Timr 9;  P. Smíšek 1;  V. Vávra 1;  K. Zdráhalová 1;  P. Sedláček 1;  L. Šrámková 1;  V. Komrska 1;  E. Mejstříková 1;  A. Vrzalová 1;  K. Kramarzová 1;  K. Michalová 10;  Z. Zemanová 10;  M. Jarošová 11;  J. Housková 12;  J. Zuna 1;  O. Hrušák 1;  J. Trka 1;  V. Mihál 4
Authors‘ workplace: Klinika dětské hematologie a onkologie UK 2. LF a FN Motol, Praha, 2I. dětská interní klinika LF MU a FN Brno, 3Klinika dětské onkologie FN Brno, 4Dětská klinika LF UP a FN Olomouc, 5Klinika dětského lékařství FN Ostrava, 6Dětská klinika FN Hradec Králové 1
Published in: Transfuze Hematol. dnes,14, 2008, No. 3, p. 102-109.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

Treatment of childhood acute lymphoblastic leukemia (ALL) according to the protocol ALL-BFM 95 was performed at 8 departments of pediatrics between 1996–2002 in the Czech Republic. Patients were stratified into 3 risk groups (standard risk-SR, medium risk-MR and high risk-HR) according to the early treatment response, age, initial WBC and the finding of translocations t(9;22) or t(4;11). Total duration of treatment was 2 years except for boys of SR for whom it was three years. 386 children were enrolled into the study and the treatment results were evaluable in 380 patients with a median follow-up of 8.2 years. Complete remission (CR) was achieved in 95.5% pts, 3.9% children died in CR. Stratification into the risk groups was as follows: SR 32.4%, MR 53.7% and HR 13.9%. 69 children (19%) suffered from relapse, isolated CNS relapse has been diagnosed only in 1.1%. Two children (0.6%) developed secondary cancer. Event-free survival (EFS) is 73.1% and overall survival (OS) 80.8%. The results improved in comparison with previous study ALL-BFM 90 (EFS 71.3%; OS 76.4%) despite treatment reduction for 2/3 of patients. EFS/OS were in SR 84.5/93.2%, MR 74/82.1% and HR 43.1/47.1%. The prognosis of T-ALL (EFS 64.8%) was significantly worse in comparison with BCP-ALL (EFS 75.8%). Only 7 children underwent stem cell transplantation in the first CR. Survival of children with ALL in the Czech Republic exceeded 80%. Significant improvement was particularly achieved in HR group (EFS in previous study only 28.2%).

Key words:
acute lymphoblastic leukemia, children, chemotherapy, protocol ALL-BFM 95, relapse


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