PubMed1979
495 children and adolescents with acute lymphoblastic leukemia entered a non-randomized therapy study between January 1st, 1971, and December 31st, 1974. They were treated at 40 pediatric clinics in the Federal Republic of Germany according to the protocol of the Deutsche Arbeitsgemeinschaft für Leukämieforschung und -Behandlung im Kindesalter, which was closely adapted to the Memphis protocol VII. These patients were analyzed retrospectively, data of evaluation was July 31st, 1978. 7 patients (1.4%) did not achieve remission, 14 patients (2.8%) died during the induction period, and another 37 patients (7.5%) died in continuous complete remission (CCR). For purposes of comparison only the remaining 437 patients were evaluated (remission group). The 7 1/2 years' probability of CCR is 0.33 +/- 0.02 for the total group (495 patients) and 0.37 +/- 0.03 for the remission group. The probability of survival for these groups is 0.40 +/- 0.03 and 0.45 +/- 0.03, respectively. After relapse the 5 years' probability of survival is 0.03 +/- 0.02. Patients with testicular relapse have a markedly better prognosis compared to those with bone-marrow or central nervous system relapses. The most important prognostic factor was found to be the white blood count at diagnosis. There is a negative correlation between the initial white blood count and the probability of CCR. Girls fared significantly better than boys (0.46 +/- 0.04 vs 0.31 +/- 0.03 in CCR, p less than 0.01). There is convincing evidence that the impaired prognosis in boys is at least partly due to the incidence of testicular relapses (36 of 268 relapses were found to be testicular, isolated in 20 patients and combined with bone-marrow relapse in 16 patients). Patients with thymic involvement and/or positive reaction of the acid phosphatase in their blast cell did significantly worse (0.12 +/- 0.05 in CCR). Irradiation of the skull was performed in two different doses (1800 and 2400 rads). Concerning the incidence of relapses primarily located in the central nervous system patients with low-dose irradiation had no worse prognosis than those with high-dose irradiation but the incidence of bone-marrow relapses was found to be higher in the 2400 rad group (50.5% vs. 41.7% in the 1800 rad group), possibly due to the higher initial white blood count (median 8900/mul vs. 6500/mul). The addition of vincristine/prednisone reinduction courses during the first year of continuation therapy showed no significant advantage.