Treatment of childhood acute lymphoblastic leukemia in Jakarta: Result of modified Indonesian National Protocol 94

Djajadiman Gatot; Endang Windiastuti

doi:10.14238/pi46.4.2006.179-84

Djajadiman Gatot
Endang Windiastuti

DOI: https://doi.org/10.14238/pi46.4.2006.179-84

Keywords: acute lymphoblastic leukemia, childhood, survival

Abstract

Background Before 1990, the survival rates of childhood acute
lymphoblastic leukemia (ALL) patients remained low. In 1994, the
Hematology Oncology Working Group of the Indonesian Pediatric
Association constructed a national protocol based on standard in-
ternational protocol. As the outcome was still not promising, in 1998
the protocol was modified by introducing low dose MTX infusion for
CNS prophylaxis.
Objective To analyze the survival of pediatric ALL patient treated with
the modified protocol in Cipto Mangunkusumo Hospital, Jakarta.
Methods A prospective study was carried out to all newly diag-
nosed and relapsed children with ALL from January 1998 through
December 2004. Patients were stratified into standard risk group
(SRG) and high risk group (HRG). HRG met with one of these
criteria: WBC >50 000/Ã¬l, the presence of CNS involvement, medi-
astinal mass, relapse, or L 3 morphology. After completing induc-
tion therapy, all patients received low-dose MTX (LDMTX) infusion
(500 mg/m 2 ), especially for those aged less than 3 years. If the
patient could not afford LDMTX, cranial irradiation (CRT) was given.
Results There were 309 patients, consisted of 190 SRG and 119 HRG
patients. Male to female ratio was 1.8:1. Complete remission was
achieved in 86.3% SRG patients compared with 63.8% in HRG pa-
tients (P<0.05). Event-free survival (EFS) rate in SRG and HRG were
65.9% (95%CI 59.8; 71.9%) and 40.4% (95%CI 32.5; 48.4%), respec-
tively. The overall survival (OS) rates in SRG was 81.2% (95%CI 76.3;
86.2%) and in HRG was 56.0% (95%CI 47.8; 64.2%). The overall OS
and EFS for both groups were 71.6% (95%CI 67.0; 76.2%) and 59.6%
(95%CI 54.5; 64.7%), respectively. Failure of therapy was mostly due
to severe aplasia resulted in bleeding and severe infection. CNS re-
lapse was rare in both groups, i.e. 3.1% in SRG and 0.8% in HRG.
Conclusion Treatment of ALL using modified national protocol for
SRG shows promising results. However, the outcome of HRG pa-
tients is still inferior to those reported elsewhere. The use of low-
dose MTX infusion can replace the role of cranial irradiation as
CNS prophylaxis measure.

Author Biographies

Djajadiman Gatot

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.

Endang Windiastuti

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.

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