Background: As in LMICs, the prognosis of childhood ALL in Indonesia was
lower than in HICs. Indonesian-ALL2013 protocol resulted in more
toxicities and abandonments than expected. Therefore, it was modified
into a pilot ALL2016 protocol. Changes to the ALL2013 protocol: no
anthracyclines in SR, dexamethasone replaced prednisone in reinduction
for HR and some drugs were rescheduled. Procedure: We compare the
outcome of ALL2013 and ALL2016. Results: A total of 383 children with
ALL were diagnosed, 21 were excluded. ALL2013 included 174 patients (106
SR and 68 HR) and ALL2016 188 (91 SR and 97 HR). The outcome of the
ALL2016 was better than the ALL2013 (pOS 67.0% vs 60.3%; p=0.087 and
pEFS 50.0% vs 37.9%; p=0.012) even when the number of HR patients was
significantly higher in ALL2016 (51.6% vs 39.1%). The ALL2016 showed
an early advantage for SR patients (pEFS 56.7% vs 47.2%; p=0.114 and
pOS 74.4% vs 69.8%; p=0.298) due to the decrease of toxic deaths
(10.4% vs 5.5%; p=0.211) however the number of late relapses were
still high (19.5% vs 13.2%; p=0.282). In the HR group, both pEFS and
pOS were significantly better in ALL2016 (pEFS 43.3% vs 23.5%; p=0.010
and pOS 59.8% vs 45.6%; p=0.036) due to less relapses (14.4% vs
29.4%; p=0.019). Both SR and HR showed a smaller number of abandonments
in ALL2016. Conclusions: After small changes in protocol, initial
toxicity and abandonments were reduced and the pOS and pEFS were
improved. However, relapses still need to be lessened in the next
protocol.
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