Acute Lymphoblastic Leukemia: Ten Years Experience in Nemrock

Purpose: We studied the frequency, causes, and predictors of adverse events in children with acute lymphoblastic leukemia (ALL) who had completed treatment on contemporary clinical protocols between 1999 and 2003. Our goal was to use the information to further refine therapy and advance cure rates. Methods: From January 1999 to December 2003, 119 consecutive children and adolescents 18 years of age or younger with newly diagnosed ALL were treated at Kasr El Aini Center of Medical Oncology. All relapsing patients received a modified protocol of BFMREZ 85. Assessment of different prognostic factors related to relapse was done in terms of event free survival. Results: Out of the 119 patients 96 completed all treatment while in initial complete remission. After a median follow-up of 7 years, 17 patients subsequently had major adverse events, including 15 leukemic relapses, one second malignancy, and one death in remission. The risk of any leukemic relapse was 15.6% at 5 years and 17.7% at 10 years. Male sex was the only independent predictor of relapse (p=0.01). Despite risk-adapted treatment, an early time point of relapse and T-lineage immunophenotype were significant predictors of inferior event free survival (EFS) in uni- and multivariate analyses. Conclusion: Further treatment refinements for children with ALL should aim not only to decrease the leukemic relapse rate, but also to reduce the risk of development of second malignancies.