Treatment of acute lymphoblastic leukemia with protocol Hongkong–Indonesia Acute Lymphoblastic Leukemia 97
Keywords:
Childhood ALL, Protocol Hong Kong-Indonesia Acute Lymphoblastic Leukemia 97
Abstract
Background The HK-Ina ALL 97 study protocol is based on theTherapy Study ALL-BFM 95 protocol. Basically, this protocol
stratifies the patients into three groups, i.e. standard risk for low
risk group (SR), intermediate risk (IR), and high risk (HR) group,
and the treatment is directed according to the risk groups.
Objectives To investigate the overall treatment result of childhood
ALL in Indonesia and to stratify patients according to biological,
clinical criteria, and molecular study that identify the standard
and high risk patients with greater precision.
Methods Twenty patients entered in this study; 10 SR, 6 IR and 4
HR groups. Induction phase for SR group consisted of four drugs
(phase I’a) for five weeks and three drugs combination (phase I’b)
for four weeks. Consolidation phase consisted of four doses of mini-
HD MTX (2 gram/m 2 ) (protocol M’), reinduction phase used
dexamethasone for seven weeks, and maintenance phase consisted
of 6 MP and MTX. Boys, who were at higher risk of relapse, were
given pulse dexamethasone and vincristine. Induction phase for IR
was the same as SR, but four doses of daunorubicin were given to IR
group (Ia). Consolidation phase included four doses HDMTX (5
gram/m 2 ). Phase Ib and Protocol II was the same as SR group. Pulse
dexamethasone and vincristine was given to all patients. Induction
phase for HR group will be the same as IR group. This followed by
three blocks of very intensive treatment. Two reinduction phases
and maintenance was the same as SR and IR groups.
Results Nineteen of 20 patients achieved complete remission (CR).
The patient who could not stand was a 10 years old boy with initial
WBC 612X10 9 /L, T-lineage marrow. He died 5 months since the initial
diagnosis after treated with HDMTX with dominant CD33 and sepsis.
Conclusion The EFS in this study is 95% for the observation of 5
months through five years and two months. It is still expected that
the result fall off in the subsequent year, but it is also expected to be
comparable to 70-80%. The very intensive and toxic program for
HR group, may improve the EFS, but may also cause secondary
AML in the earlier time.
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9. Reiter A, Schrappe M, Ludwig WD, Lampert F, Harbott J, Henze
G, et al. Favourable outcome of B-cell acute lymphoblastic leu-
kemia in childhood: A report of three consecutive studies of
the BFM group. Blood 1992; 80:2471-8.
10. Kaspers GJ, Veerman AJ, Popp-Snijders C, Lomecky M, Van
Zantwijk CH, Swinkels LM, et al. Comparison of antileuke-
mic activity in vitro of dexamethesone and prednisolone in
childhood acute lymphoblasti leukemia. Med Pediatr Oncol
1996; 27:114-21.
11. Bleyer WA, Sather HN, Nickerson HJ, Coccia PF, Finklestein
JZ, Miller DR, et al. Monthly pulses of vincristine and pred-
nisone prevent bone marrow and testicular relapse in low risk
childhood acute lymphoblastic leukemia: a report of the CCG-
161 study by the Childrens Cancer Study Group. J Clin Oncol
1991; 9:1012-21.
Trigg ME. Augmented Berlin-Frankfurt-Munster therapy ab-
rogates the adverse prognostic significance of slow early re-
sponse to induction chemotherapy for children and adoles-
cents with acute lymphoblastic leukemia and unfovourable
presentating features: A report from the Children’s Cancer
Group. J Clin Oncol 1997; 15:2222-30.
2. Rivera GK, Raimondi SC, Hancock ML, Behm FG, Pui CH,
Abromowitch M, et al. Improved outcome in childhood acute
lymphoblastic leukemia with reinforced early treatment and ro-
tational combination chemotherapy. Lancet 1991; 337:61-6.
3. Turbergen DG, Gilchrist GS, O’Brien RT, Coccia PF, Sather
HN, Waskerwitz MJ, et al. Improved outcome with delayed
intensification for children with acute lymphoblastic leuke-
mia and intermediate presenting features: a Children Can-
cer Group phase III trial. J Clin Oncol 1993;11:527-37
4. Conter V, Arico M, Valsecchi MG, Rizzari C, Testi AM,
Messina C, et al. Extended intrathecal methotrexate may
replace cranial irradiation for prevention of CNS relapse
in children with intermediate-risk acute lymphoblastic leu-
kemia treated with Berlin-Frankfurt-Munster-based inten-
sive chemotherapy. The Associazione Italiana di
Ematologia ed Oncologia Pediatrica. J Clin Oncol 1995;
13:2480-2.
5. Protocols and Committee Progress Reports of 8 th Annual
Meeting of International BFM Study Group, 25-27 April
1997.
6. Chessell JM, Bailey C, Richards SM. Intensification of treat-
ment and survival in all children with lymphoblastic leuke-
mia; results of UK Medical Research Council trial UKALL
X. Medical Research Council Working Party on Childhood
Leukemia. Lancet,1995; 345:143-8.
7. Pullen J, Boyett J, Shuster J, Crist W, Land V, Frankel L, et
al. Extended triple intrathecal chemotherapy trial for pre-
vention of CNS relaps in good-risk and poor-risk patients
with B-progenitor acute lymphoblastic leukemia: a Pedi-
atric Oncology Group study. J Clin Oncol 1993; 11:839-
49.
8. Reiter A, Schrappe M, Ludwig WD, Hiddemann W, Sauter
S, Henze G, et al. Chemotherapy in 998 unselected child-
hood acute lymphoblastic leukemia patients. Results and con-
clusions of the multicenter trial ALL-BFM 86. Blood, 1994;
84:3122-33.
9. Reiter A, Schrappe M, Ludwig WD, Lampert F, Harbott J, Henze
G, et al. Favourable outcome of B-cell acute lymphoblastic leu-
kemia in childhood: A report of three consecutive studies of
the BFM group. Blood 1992; 80:2471-8.
10. Kaspers GJ, Veerman AJ, Popp-Snijders C, Lomecky M, Van
Zantwijk CH, Swinkels LM, et al. Comparison of antileuke-
mic activity in vitro of dexamethesone and prednisolone in
childhood acute lymphoblasti leukemia. Med Pediatr Oncol
1996; 27:114-21.
11. Bleyer WA, Sather HN, Nickerson HJ, Coccia PF, Finklestein
JZ, Miller DR, et al. Monthly pulses of vincristine and pred-
nisone prevent bone marrow and testicular relapse in low risk
childhood acute lymphoblastic leukemia: a report of the CCG-
161 study by the Childrens Cancer Study Group. J Clin Oncol
1991; 9:1012-21.
Published
2007-05-01
How to Cite
1.
Lukito J. Treatment of acute lymphoblastic leukemia with protocol Hongkong–Indonesia Acute Lymphoblastic Leukemia 97. PI [Internet]. 1May2007 [cited 15Nov.2024];47(2):88-2. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/351
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Received 2016-08-25
Accepted 2016-08-25
Published 2007-05-01
Accepted 2016-08-25
Published 2007-05-01
