Treatment of acute lymphoblastic leukemia with protocol Hongkong–Indonesia Acute Lymphoblastic Leukemia 97

Abstract

Background The HK-Ina ALL 97 study protocol is based on the
Therapy 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.