Extended Follow-Up of Children with High-Risk Acute Lymphoblastic Leukemia Treated with American and European Protocols - A Clash of Different Ideas

Kinga Kwiecinska, Zakrzewska Zuzanna, Wojciech Strojny, Magdalena Cwiklinska, Walentyna Balwierz and Szymon Skoczen

Department of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Poland
University Children Hospital, Poland

^*Correspondance to: Szymon Skoczen 

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Abstract:

Purpose: To assess long-term outcomes in children with high risk ALL treated according to American and European protocols.
Methods: A group of 74 children treated with New York like protocols was compared to a group of 45 children treated according to ALLIC-2002. All studied patients had initial WBC ≥ 50 × 109/L. NY consisted of very intensive, repeated multidrug cycles administered over the period of 3 years, whereas ALLIC provided intensive multidrug chemotherapy for 7 months in IRG and 9 months in HRG, followed by maintenance therapy applied for up to two years of treatment.
Results: After more than 5 years of follow-up 57 (77%) of NY and 33 (73%) of ALLIC patients are alive in first complete remission. There were 13 (17.6%) and 9 (20%) relapses as well as 16 (9.4%) and 7 (15.6%) deaths respectively. Five-year EFS and OS in NY were 77%/78% and in ALLIC 73%/83.6% respectively. HSCT after relapse was performed in 1 patient from NY. There were 13
HSCT performed in I RC and 3 after relapse in ALLIC group. Relapses and other adverse events occurred mostly in patients with WBC ≥ 100 × 109/L.
Conclusion: Generally, the achieved results were satisfactory and comparable to those observed in other centers at that time. OS in the NY patients was inferior mainly due to lack of effective HSCT procedures commonly available for ALLIC patients. Despite higher intensity of NY we did not observe more fatal events not related to the relapse; however the frequency of late side effects
in NY treated patients was probably higher. The criterion of initial leukocytosis WBC ≥ 100 × 109/L still indicates children with high risk of relapse and death, although modern risk criteria (mainly MRD and genetic evaluation) are much better for adequate risk stratification.

Keywords:

Acute lymphoblastic leukemia; Risk factors; Stratification; Leukocytosis

Cite the Article:

Kwiecinska K, Zuzanna Z, Strojny W, Cwiklinska M, Balwierz W, Skoczen S. Extended Follow-Up of Children with High-Risk Acute Lymphoblastic Leukemia Treated with American and European Protocols - A Clash of Different Ideas. Clin Oncol. 2020;5:1759..