Relapse in Children with ALL

By Dr Kaji

Protocol for Acute LymphoblasticLeukemia Relapse IN LANZKOWSKY

Outcome After First Relapse in Children With Acute Lymphoblastic Leukemia:A Report Based on the Dutch Childhood Oncology Group (DCOG) Relapse ALL 98 Protocol

Conclusions. Our data suggest the superiority of SCT for early relapse patients. For late relapses a better outcome is achieved with chemotherapy only using the rotational chemotherapy scheme. The most important factor for survival was interval between first CR and occurrence of the first relapse. Pediatr BloodCancer. 2011;57:210–216. 2011 Wiley-Liss, Inc.

Outcome of Childhood Acute Lymphoblastic Leukemia With Induction Failure Treated by the Japan Association of Childhood Leukemia Study (JACLS) ALL F-Protocol

The aim of this prospective study was to evaluate the efficacy and safety of the Japan Association of Childhood Leukemia Study (JACLS) ALL F-protocol on the outcome of childhood ALL with IF.

This protocol consists of AML-oriented re-induction and consolidation block therapies followed by allogeneic HCT.

Patients obtaining CR by the end of the first consolidationtherapy were scheduled to receive HCT after the second consolidation therapy but before maintenance therapy

Maintenance therapy consisted of three alternatingblocks for 18 months (Supplemental Table I).

In conclusion,

the F-protocol consisting of AML-oriented blocktherapies followed by allogeneic HCT can improve the prognosis for non-Ph ALL patients with IF. However, to improve the chemotherapy regimen of the F-protocol we plan close MRD monitoring in future studies.

Protocol R16Treatment element/drug single or daily dose days givenWindow Topotecan 2.4mg/m2/ IV over 30 min 1- 5 dayInduction 1)Dexamethasone 6mg/m2/day po 8-35 day 2)Vincristine 1.5mg/m2/IV 8,15,22,2 3)L.ASP 10.000u/m2/IM(or Erwinia if 8,11,13,15,18,20 Previous allergy to E.coll.) 22,25,27,29,32,34 PEg-ASP 2500u/m2/IM 8,15,22,29 4)IT MHA 8,22,36

Consolidation 1)Fludurabine 15mg/m2/IVinf30’ 1,2,3,4 2)Ara-C 2mg/m2/IV 1,2,3,4Secondary Consolidation(for patients not undergoing bone marrow transplant)

1)VP16 50mg/m2 po qd 14 days 2)Vincristine 1.5mg/m2(max:2mg)IV 1,8 3)IT (MHA) day1

Continuation Chemotherapy Cycle1: 1)CPM 1gr/m2/IV 1,2 2)Vincristine 1.5mg/m2/IV 1Cycle2: 1)VP16 50mg/m2/po d x14day 2)Decadlon 6mg/m2/po 3)VCR 1.5mg/IV(max:2mg) 1-8Cycle3: 1)HD Mtx 5gr/m2 Infusion for 24 hrs 2)L. Asp 10,000 u/m2/dose IM qodx3 orPEG Asp 2500u/m2/dose IMX1Cycle4: 1)HD Ara-C 2g/m2/dose IV over2hrs q12hrx3dose(total:6g/m2) 2)Idarubicin 12mg/m2/IV over30’ 1day( Completion of first dose Ara-C) 3)IT (MHA) on day 1 prior to th HD Ara-C

Standard Continuation Chemotherapy:patients will receive 4-week rotatational cycles of chemotherapy with the following pairs of drugs for total treatment duration of 17 months. Week#1: CPM 300mg/m2/IV VCR 1.5mg/m2/IV Week#2: VM26 200mg/m2/IV Ara-C 300mg/m2/IVWeek#3: MTX 40mg/m2/IM or (IV 2 hrs infusion if previous C.R) 6MP 75mg/m2 po q Hs x 7Week#4: Mtx 40mg/m2/IM or (IV 2 hrs infusion if previous C.R) 6MP 75mg/m2/po q h s x 7 IT(MHA) q8 weeks for patient CNS I and q 4 weeks for patient CNS2/3 who will receive CSI at end