Author/Authors :
Al-Nasser, Abdallah King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children’s Cancer Research - Department of Pediatric Hematology/Oncology, Saudi Arabia , El-Solh, Hassan King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children’s Cancer Research, - Department of Pediatric Hematology/Oncology, Saudi Arabia , De Vol, Edward King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children’s Cancer Research, - Biostatistics, Epidemiology Scientific Computing, Saudi Arabia , El-Hassan, Ibrahim King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children’s Cancer Research, - King Faisal Cancer Center, Saudi Arabia , Al-Sudairy, Reem King Fahad National Guard Hospital - Department of Pediatrics, Saudi Arabia , Al-Mahr, Mohammed King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children s Cancer Research - Department of Pediatric Hematology/Oncology, Saudi Arabia , Al-Musa, Abdulrahman King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children s Cancer Research - Department of Pediatric Hematology/Oncology, Saudi Arabia , Al-Jefri, Abdulla King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children s Cancer Research - Department of Pediatric Hematology/Oncology, Saudi Arabia , Saleh, Mahasen King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children s Cancer Research - Department of Pediatric Hematology/Oncology, Saudi Arabia , Rifai, Samira King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children s Cancer Research - Department of Pediatric Hematology/Oncology, Saudi Arabia , Belgaumi, Asim King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children s Cancer Research - Department of Pediatric Hematology/Oncology, Riyadh , Osman, Layla King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children s Cancer Research - Department of Pediatric Hematology/Oncology, Saudi Arabia , Ashraf, Khairy King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children s Cancer Research - Department of Pediatric Hematology/Oncology, Saudi Arabia , Salim, Mohammed King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children s Cancer Research - Department of Pediatric Hematology/Oncology, Saudi Arabia , Silo, Ameurfina King Khaled Eye Specialist Hospital - Quality Management Department, Saudi Arabia , Roberts, George King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children s Cancer Research - Department of Pediatric Hematology/Oncology, Saudi Arabia , Alzahrani, Ali King Faisal Specialist Hospital Research Centre and King Fahad National Centre for Children’s Cancer Research - Biostatistics, Epidemiology Scientific Computing, Saudi Arabia
Abstract :
Background and Objective: Because of the need for more comprehensive information on the least toxic and most effective forms of therapy for children with acute lymphoblastic leukemia (ALL), we reviewed our ex-perience in the treatment of children with ALL at King Faisal Specialist Hospital and Research Centre (KFSH RC) and King Fahad National Center for Children s Cancer and Research (KFNCCC R) over a period of 18 years with a focus on patient characteristics and outcome.Methods: During the period of 1981 to 1998, records of children with ALL were retrospectively reviewed with respect to clinical presentation, laboratory findings, risk factors, stratification, therapy and outcome. The protocols used in treatment included 4 local protocols (KFSH 81, 84, 87 and 90), and subsequently, Children s Cancer Group (CCG) protocols, and these were grouped as Era 1 (1981-1992) and Era 2 (1993-1998). Results: Of 509 children with ALL treated during this period, 316 were treated using local protocols and 193 using CCG protocols. Drugs used in Era 1 included a 4-drug induction using etoposid (VP-16) instead of L-asparaginase. Consolidation was based on high dose methotrexate (MTX) 1g/m 2 and maintenance was based on oral mercaptopurine (6-MP) and MTX with periodic pulses using intravenous teniposide (VM-26), Ara-C, Lasparaginase, adriamycin, prednisone, VP-16 and cyclophosphamide. International protocols were introduced in Era 2, which was also marked by intensification of early treatment, a wider selection of cytoreductive agents, and the alternating use of non-cross-resistant pairs of drugs during the post-remission period. The end-of-induc-tion remission rate improved from 90% in Era 1 to 95% in Era 2, which was of borderline statistical signifi-cance (P=.049). The 5-year event-free survival (EFS) improved from 30.6% in Era 1 to 64.2% in Era 2 (P .001). Improvement in outcome was achieved without any significant increase in morbidity or mortality, due to im-provement in both systemic therapy and supportive care. The most important independent prognostic factors were intensity of therapy, poor risk category assignment and CNS disease at diagnosis. Conclusion: Outcome in children with ALL has improved because of intensification of treatment protocols and better supportive care.
