Indian Pediatr 2012;49: 248
Does Choice of Treatment Protocol have Impact
on outcome in T-cell Lymphoblastic Leukemia?
Mohammed Ramzan and Satya Prakash Yadav
Pediatric Hematology Oncology and Bone
Marrow Transplant Unit, Institute of Child Health,
Sir Ganga Ram Hospital, Delhi 110 060, India.
3), which is lower
than 58.3% reported by Arya, et al. . Children were treated as
per BFM-95, UKALL-XI, MCP-841 and Interfant-99 protocols. Twelve (29.2%)
were lost to follow up (LFU) and 29 opted for treatment, of these
24(82.7%) achieved complete remission (CR1). Four died in induction and
one had refractory disease. Four died in remission. Nine (31%) relapsed
(Medullary-4, combined-3, testicular-1,isolated CNS-1). Eleven (38%)
patients are alive and in CR1.Eighteen patients were treated on BFM 95
protocol (14 medium risk and 4 high risk as per BFM-95 risk
stratification), of these 13 achieved CR1, 4 died in induction and 1 had
refractory disease. Out of 13, 8 are in CR1 (at median follow up of 2.5
years), one relapsed and 4 had remission deaths. Ten patients were
treated on UKALL-XI protocol, 9 achieved CR1 and 1 died in induction.
Out of 9 in CR1, 7 relapsed, 1 alive and 1 LFU. Two patients were
treated on MCP-841 protocol one is in CR1 and 1 LFU. One infant was
treated on Interfant-99 protocol who relapsed at 18 months from
diagnosis and died. Relapse rate was significantly lower for more
intensive BFM-95 as compared to UKALL-XI protocol (P-value
0.001). However treatment related mortality was very high (44%) for
BFM-95 as compared to 10% for UKALL-XI protocol. Our results are
inferior to original BFM-95 protocol (74.8% 6-year event free survival
(EFS) in T-cell ALL)  while UKALL XI protocol  showed 61% 8-year
EFS with no separate data for T-immunophenotype. We conclude that choice
of treatment protocol has huge impact on outcome in T-cell ALL.
We read the article by Arya, et al. on T-cell
acute lymphoblastic leukemia (ALL) outcome with interest . Although
ALL outcome has improved in India but sepsis and loss to follow up
remain barriers to improving outcome . Here we describe impact of
choice of protocol on patients with T-cell ALL at our center. Out of 288
children newly diagnosed as ALL between July 2005 to Jan 2011, 41
(14.2%) had T-cell ALL, which is similar to Western data 15-18% .
However, it is much lower than that reported by Arya, et al.
(30%) . Median age of presentation was 7.5 years (9 month-18 years)
(M:F=6:1) and 34% aged >10 years. 39% patients had hyperleukocytosis
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