First Relapse of Acute Lymphoblastic Leukemia in Children in Upper Egypt: Survival Outcome and Prognostic Factors

Document Type : Original Article

Authors

1 Pediatric Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

2 Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

Abstract

Background: Relapse is the main reason of treatment failure in childhood acute Lymphoblastic leukemia (ALL).
Aim: To study the treatment outcome of first ALL relapse in response to two different reinduction regimens and prognostic factors predicting outcome.
Methods: A retrospective study that included 82 children with ALL in the 1st relapse from two tertiary oncology centers in Upper Egypt. Patients were treated according to the St. Jude ALL-R16 protocol. Seventeen patients were treated with a standard reinduction (regimen 1) and 65 were treated with a modified reinduction regimen in which anthracycline was added and asparaginase was reduced to 9 doses (regimen 2). Response, survival and prognostic factors were analyzed.
Results: Second, complete remission (CR2) was achieved in 57% of all patients (65% with regimen 2 vs. 29% with regimen 1, p = 0.009).  FLAG regimen resulted in achieving CR2 in all patients with reinduction failure. Treatment related mortality was more common with regimen 2 than with regimen 1 (34% vs. 12%, respectively). For all patients, the 2-year overall and event-free survival rates were 30% and 25%. In multivariate analysis, high initial total leukocytic count, isolated medullary relapse, regimen 1 and very early relapse were independently associated with worse event free survival (p = 0.031, 0.017, 0.037 and 0.001; respectively).
Conclusions: The overall outcome of treatment of first ALL relapse in children in our region is poor. New intensive chemotherapy regimens may help in improving the treatment outcome.

Keywords

Research in Oncology
Volume 17, Issue 2
December 2021
Pages 51-59

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