scholarly journals 3-year survival rate in acute lymphoblastic leukemia: comparison of ALL-2006 and ALL-2013 Protocols

2021 ◽  
Vol 61 (3) ◽  
pp. 155-64
Author(s):  
Avyandita Meirizkia ◽  
Dewi Rosariah Ayu ◽  
Raden Muhammad Indra ◽  
Dian Puspita Sari
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Survival Rate ◽  
High Risk ◽  
Risk Group ◽  
Lymphoblastic Leukemia ◽  
Survival Rates ◽  
High Risk Group ◽  
Age At Diagnosis ◽  
Protocol Group ◽  
Remission Rates

Background With advances in supportive and risk-stratified therapy, the 5-year survival rate of acute lymphoblastic leukemia has reached 85.5%. The ALL-2006 treatment protocol was modified and renamed the ALL-2013 protocol, with dose and duration changes. Objective To compare outcomes of the ALL-2006 and ALL-2013 protocols, with regards to mortality, remission, relapse, and three-year survival rates. Methods This was retrospective cohort study. Subjects were acute lymphoblastic leukemia (ALL) patients treated from 2011 to 2018 in Mohamad Hoesin Hospital, Palembang, South Sumatera. The three-year survival rates, relapse, remission rates and comparison of ALL-2006 and ALL-2013 protocols were analyzed with Kaplan-Meier method. Results Mortality was significantly correlated with age at diagnosis <1 year and >10 years, hyperleukocytosis, and high-risk disease status. Patients aged 1 to 10 years, with leukocyte count <50,000/mm3 and standard-risk status had significantly higher likelihood of achieving remission. Mortality was not significantly different between the ALL-2006 protocol group [70.6%; mean survival 1,182.15 (SD 176.89) days] and the ALL-2013 protocol group [72.1%; mean survival 764.23 (SD 63.49) days]; (P=0.209). Remission was achieved in 39.2% of the ALL-2006 group and 33% of the ALL-2013 group (P>0.05). Relapse was also not significantly different between the two groups (ALL-2006: 29.4% vs. ALL-2013: 17.9%; P>0.05). Probability of death in the ALL-2006 group was 0.3 times lower than in the ALL-2013 group (P<0.05), while that of the high-risk group was 3 times higher. Remission was 2.19 times higher in those with leukocyte <50,000/mm3 compared to those with hyperleukocytosis. In addition, relapse was significantly more likely in high-risk patients (HR 2.96; 95%CI 1.22 to 7.19). Overall, the 3-year survival rate was 33%, with 41.7% in the ALL-2006 group and 30.7% in the ALL-2013 group. Conclusion Three-year survival rate of ALL-2006 protocol is higher than that of ALL-2013 protocol but is not statistically significant.  Age at diagnosis <1 year and >10 years, hyperleukocytosis, and high-risk group are significantly correlated with higher mortality and lower remission rates. However, these three factors are not significantly different in terms of relapse.   

scholarly journals ANALYSIS OF INDUCTION PHASE GLUCOCORTICOID USE ON ADRENAL SUPPRESSION IN PEDIATRIC PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA

2017 ◽  
Vol 52 (1) ◽  
pp. 7
Author(s):  
Octaviana Simbolon ◽  
Yulistiani Yulistiani ◽  
I DG Ugrasena ◽  
Mariyatul Qibtiyah
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Risk Group ◽  
Lymphoblastic Leukemia ◽  
High Risk Group ◽  
Adrenal Suppression ◽  
Induction Phase ◽  
Childhood All ◽  
Cortisol Levels ◽  
Standard Risk

Glucocorticoids play an important role in the treatment of acute lymphoblastic leukemia (ALL). However, supraphysiological doses may cause suppression of the adrenal. Adrenal suppression resulting in reduced cortisol response may cause an inadequate host defence against infections, which remains a cause of morbidity and mortality in children with ALL. The occurrence of adrenal suppression before and after glucocorticoid therapy for childhood ALL is unclear. The aim of this study is to analysis the effect of glucocorticoid on cortisol levels during induction phase chemotherapy in children with acute lymphoblastic leukemia. A cross-sectional, observational prospective study was conducted to determine the effect of glucocorticoid on cortisol levels in children with acute lymphoblastic leukemia. Patients who met inclusion criteria were given dexamethasone or prednisone therapy for 49 days according to the 2013 Indonesian Chemotherapy ALL Protocol. Cortisol levels were measured on days 0, 14, 28, 42 and 56 of induction phase chemotherapy. There were 24 children, among 31 children recruited, who suffered from acute lymphoblastic leukemia. Before treatment, the means of cortisol levels were 228.95 ng/ml in standard risk group (prednisone) and 199.67 ng/ml in high risk group (dexamethasone). In standard risk group, the adrenal suppression occurs at about day 56. There was a significant decrement of cortisol levels in high risk group in days 14, 28, 42 against days 0 of induction phase (p=0.001). Both groups displayed different peak cortisol levels after 6 week of induction phase (p=0.028). Dexamethasone resulted in lower cortisol levels than prednisone during induction phase chemotherapy in children with acute lymphoblastic leukemia.

Detection of multidrug-resistant, gene-related proteins for postoperative individualized chemotherapy of gastric cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 156-156
Author(s):  
Pengfei Yu
Keyword(s):  
Risk Factors ◽  
Survival Rate ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Risk Group ◽  
Survival Rates ◽  
High Risk Group ◽  
Low Risk ◽  
The Difference ◽  
Topo Ii

156 Background: Postoperative adjuvant chemotherapy was beneficial for some patients,however, it may increase the treatment burden and reduce the immunity of other patients. Screening appropriate patients based on molecular markers for individualized adjuvant chemotherapy was necessary. Methods: Between June 2002 to June 2004, 119 patients who underwent radical gastrectomy were retrospectively analyzed. 61 patients had adjuvant chemotherapy based on platinum and 5-FU for 4 to 6 cycles. ToPo II negative, MRP positive and GST-π positive were regarded as three risk factors which may be associated with chemotherapy resistance and poor prognosis. Patients were divided into two groups: high-risk group (≥2 risk factors) and the low-risk group (<2 risk factors), and the tumor recurrence and patients’ survival time of the two groups were analyzed. Results: The average recurrence time of the low-risk group was significantly longer than that of the high-risk group (21.29 ± 11.10 VS 15.16 ± 8.05 months ,p<0.01).The 3-year and 5-year survival rate of the high-risk group was 57.4% and 42.6%, however, it had no significant difference compared to 66.2% and 58.5% of the low-risk group (P> 0.05). In the high-risk group, the 3-year survival rate of patients with/without chemotherapy were 62.1% and 52.0%, 5-year survival rates were 44.8% and 40.0%, but the difference was not statistically significant (P> 0.05). In the low-risk group, the 3-year survival rate of patients with/without chemotherapy were 81.2% and 51.5%, 5-year survival rates were 71.9% and 45.5%, and the difference was statistically significant (p<0.05). Conclusions: Combined determination of MDR-related proteins ToPo II, MRP and GST-π may be prospectively valuable for optimizing the chemotherapy regimes, and further predicting the outcomes of gastric cancer patients.

Treatment Outcome of Discontinued L-Asparaginase in Children with Standard-Risk Acute Lymphoblastic Leukemia: Tokyo Children’s Cancer Study Group (TCCSG) Study L99-15.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 878-878 ◽  
Author(s):  
Chitose Ogawa ◽  
Akira Ohara ◽  
Atsushi Manabe ◽  
Ryoji Hanada ◽  
Hiroyuki Takahashi ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Risk Group ◽  
Lymphoblastic Leukemia ◽  
Risk Groups ◽  
High Risk Group ◽  
P Value ◽  
Group A ◽  
Group B ◽  
Standard Risk

Abstract BACKGROUND: L-asparaginase (L-asp) is one of the key drugs in the treatment of acute lymphoblastic leukemia (ALL) in children. However, L-asp often produces severe adverse effects including anaphylaxis resulting in its discontinuation. OBJECTIVE: To evaluate retrospectively the outcome of discontinuation of L-asp in patients with ALL. PATIENTS AND METHODS: Children newly diagnosed as ALL between 1999 and 2003 were consecutively enrolled on the TCCSG L99-15 study. Risk stratification was based on the age, initial white blood cell count, immunophenotype, cytogenetics and the response to prednisolone monotherapy. Totally, 267 (35%) out of 770 children were categorized into a standard-risk group (SR), 317 (41%) into a high-risk group (HR) and 186 (24%) into a very high-risk group (HEX). Allogeneic stem cell transplantation was indicated approximately in 50% of the HEX patients. L-asp was used 9 times in the induction phase in all the risk groups. The total number of L-asp administration all through the treatment was 19 in SR, 20 in HR and at least 10 in HEX. Patients were divided into two groups in the analysis: group A patients who received at least 50% of scheduled doses of L-asp and group B patients who received less than 50%. RESULTS: Remission was obtained in 259 (97%) patients in SR, 311 (98%) in HR and 171(92%) in HEX. In the patients who achieved remission and were analyzed, 195 (83.7%) in SR, 223 (78.8%) in HR and 123 (83.7%) in HEX received all the scheduled doses of L-asp. Event-free survival (EFS) (SE) and overall survival (OS) (SE) at 5 years for all the risk groups are shown in the table. Notably, EFS in group A (92.9%) and in group B (74.1%) in SR was significantly different (p=0.025). CONCLUSION: The outcome in patients who received less than 50% of scheduled dose of L-asp was inferior to that in the patients who received more than 50% of the scheduled dose. This suggests that modification or intensification of the treatment should be considered for the patients who discontinued L-asp in SR. EFS and OS in each group Risk group EFS ± SE(%) OS ± SE(%) (No. in A /B) group A group B p value group A group B p value SR (223 /10) 92.9±2.4 74.1±16.1 0.025 97.8±1.1 88.9±10.5 0.066 HR (269 /14) 78.5±3.2 66.7±19.2 0.969 88.9±2.6 50.0±25.0 0.158 HEX (142 /5) 58.2±5.5 75.5±21.7 0.514 75.6±4.3 80.0±17.9 0.873

scholarly journals ANALISIS KADAR KREATININ PADA ANAK DENGAN LEUKEMIA LIMFOBLASTIK AKUT DI PUSAT KANKER ANAK ESTELLA BLU RSUP PROF DR RD KANDOU

e-CliniC ◽  
2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Fajrul Falakh Tamsil
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Risk Group ◽  
Lymphoblastic Leukemia ◽  
High Risk Group ◽  
Good Effect ◽  
Result Show ◽  
The Impact ◽  
Standard Risk ◽  
Common Malignancy

Abstract: Malignant disease in children is one cause of death in the age group of children. Characteristic of the spread and prognosis of malignancy in children is very different with malignancy in adult. Acute Lymphoblastic Leukemia is the most common malignancy in children. Treatment with chemotherapy gifts a good effect in recent years, characterized by a decrease in mortality. How ever, as a vital organ that has function to stabilizer and organ disposal of substances that are not useful and toxic, surely chemotherapy effect on the health of kidney function. The impact of chemotherapy on renal function can be determined by examination of creatinne levels in children undergoing chemotherapy. The purpose of this study is to determine the levels of creatinine in children with acute lymphoblastic leukemia undergoing therapy in Estella Room BLU RSUP Prof Dr RD Kandou Manado. Characteristic of this study is descriptive analytic with retrospectional approach, this case done by taking patient’s medical record data from September 2012-2013. Samples were 30. Conclusion:The result obtained from 30 samples contain as many as 16 samples had normal creatinine levels, and 14 samples had not normal creatinine levels, which consisted of 15 samples with a high risk group, an 15 sample with standard risk group. Bivariat analysis result show the value of P=0.642. From this result, it can be concluded that there is no differences between creatinine levels in children with high risk group and children with standard risk group. Keywords: Acute Lymphoblastic Leukemia, Creatinine, Child    Abstrak:Penyakit keganasan pada anak merupakan salah satu penyebab utama kematian pada kelompok umur anak.Kanker pada anak sangat berbeda dengan keganasan pada orang dewasa dalam sifat, penyebaran dan prognosis.Leukimia Limfoblastik Akut merupakan keganasan yang paling sering terjadi pada anak.Penanganan dengan kemoterapi memberikan efek yang baik dalam beberapa tahun terakhir, ditandai dengan penurunan angka mortalitas.Namun sebagai organ vital yang memiliki fungsi sebagai pengatur keseimbangan dan organ pembuangan zat-zat yang tidak berguna serta bersifat toksik, tentunya kemoterapi memberikan efek terhadap kesehatan fungsi ginjal. Dampak kemoterapi terhadap fungsi ginjal dapat diketahui dengan pemeriksaan kadar kreatinin pada anak yang menjalani kemoterapi. Tujuan penelitian ini untuk mengetahui  kadar kreatinin pada anak dengan leukemia limfoblastik akut yang menjalani terapi di Ruang Estella BLU RSUP Prof. DR. R.D Kandou.Penelitian ini bersifat deskriptif analitik dengan pendekatan retrospektional, dalam hal ini dilakukan dengan pengambilan data rekam medik pasien sejak September 2012-2013. Sampel berjumlah 30 orang. Simpulan : Hasilyang didapatkan dari 30 orang sampel, terdapat sebanyak 16 sampel yang memiliki kadar kreatinin yang normal, dan 14 sampel yang memiliki kadar kreatinin yang tidak normal, yang terdiri dari 15 sampel dengan kelompok resiko tinggi(High Risk), dan 15 sampel dengan kelompok resiko standar (Standard Risk). Hasil analisis bivariat menunjukkan nilai p=0,642. Dari hasil penelitian ini dapat disimpulkan bahwa tidak adaperbedaan kadar kreatinin pada anak kelompok resiko tinggi (High Risk) LLA, dengan resiko standard (Standard Risk) LLA Kata Kunci: Leukemia Limfoblastik Akut, Kadar Kreatinin, Anak.

Treatment results in childhood acute lymphoblastic leukemia with a modified ALL-BFM’90 protocol: lack of improvement in high-risk group

1999 ◽  
Vol 23 (4) ◽  
pp. 331-340 ◽  
Author(s):  
Federico Sackmann-Muriel ◽  
Marı́a Sara Felice ◽  
Pedro Alberto Zubizarreta ◽  
Elizabeth Alfaro ◽  
Marta Gallego ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Risk Group ◽  
Lymphoblastic Leukemia ◽  
High Risk Group ◽  
Childhood Acute Lymphoblastic Leukemia ◽  
Treatment Results

Effective Risk-Adapted Therapy for Childhood B-Precursor Acute Lymphoblastic Leukemia (ALL) with the Japan Association of Childhood Leukemia Study (JACLS) ALL-97 Protocol.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1874-1874
Author(s):  
Keizo Horibe ◽  
Tooru Kudoh ◽  
Hiroki Hori ◽  
Shinichiro Nishimura ◽  
Megumi Oda ◽  
...  
Keyword(s):  
Stem Cell ◽  
Acute Lymphoblastic Leukemia ◽  
Survival Rate ◽  
High Risk ◽  
Stem Cell Transplantation ◽  
Induction Therapy ◽  
Early Phase ◽  
Risk Group ◽  
Lymphoblastic Leukemia ◽  
Maintenance Phase

Abstract BACKGROUND: With current intensified chemotherapy, more than 70% of children with acute lymphoblastic leukemia (ALL) are curable. However, prognosis of the patients at higher risk has been unsatisfied. More appropriate risk assignment and innovative treatment is expected to be developed. We conducted a clinical trial of JACLS ALL-97 including multi-agent block therapy followed by hematopoietic stem cell transplantation (SCT) for the selected higher risk patients. PATIENTS AND METHODS: Between April 1997 and March 2002, 674 patients aged 1 to 15 years with newly diagnosed ALL (excluding mature B-cell ALL) were enrolled on the JACLS ALL-97 protocol. Excluding 75 T-ALL, 26 mixed lineage leukemia other than B-precursor ALL with myeloid markers, 9 acute unclassified leukemia and 1 B-precursor ALL with pretreatment, 563 patients with B-precursor ALL were eligible for this analysis. Treatment group was divided 5 groups according to the modified National Cancer Institute (NCI) workshop criteria. Standard risk (SR) and IR (intermediate risk) divided by WBC10 × 103 account for NCI-SR. High risk (HR) and ER (extremely high risk) divided by WBC 100 × 103 account for NCI-HR. The patients with ALL positive for Philadelphia chromosome and for translocation with chromosome11q23 were assigned to the highest risk group F. The patients in complete remission (CR) at day 35 with M2/M3 at the day 14 marrow were assigned to shift higher risk after induction therapy. Treatment of ALL-97 consists of early phase and maintenance phase. Early phase includes induction therapy, consolidation therapy, sanctuary therapy, and re-induction therapy for 19 to 26 weeks dependent on risk group. Early phase in IR/HR protocol is identical to the SR protocol except the addition of two doses of DNR and three doses of CPM. Maintenance phase contains standard MTX and MP with monthly VCR and PSL intensification for SR, and rotational therapy of a set of MTX and MP with a set of VCR, PSL, ASP, and (DNR or CPM) for IR/HR/ER/F. The IR protocol is identical to the HR protocol without cranial irradiation. Treatment duration is 24 months for any risk. The patients assigned ER and F were candidate for allogeneic stem cell transplantation by the end of early phase. Transplant procedures depended on the institute. RESULTS: Number of patients at each risk was 204 for SR, 158 for IR, 128 for HR, 36 for ER, 27 for Ph+ and 10 for 11q23. Six of them were treated with incorrect risk protocol. Thirty-four patients received SCT in first CR. Following the induction therapy, 550 of 564 patients (97.5%) achieved CR. 23 patients(8 in SR, 9 in IR, 4 in HR and 2 in ER, 4.4% of all) were shift to higher risk due to the findings of day 14 marrow. Five-year overall survival rate (OS) and event-free survival rate (EFS) for all patients was 90.6% and 77.0%, respectively. Five-year EFS for NCI-SR and HR was 81.6% and 67.6%, respectively. According to risk group, 5-year EFS for SR, IR, HR, ER, Ph+ ALL, and ALL with 11q23 were 86.6%, 77.0%, 71.9%, 68.7%, 40.7%, and 70.0%, respectively. 5-year OS for them were 94.0%, 93.9%, 92.1%, 83.8%, 55.6%, and 68.6%, respectively. CONCLUSIONS: By the risk-adapted therapy in the JACLS ALL-97 trial, high cure rate could be achieved for children with B-precursor ALL.

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