Childhood ALL: Examining outcomes for patients with one or more relapses

This study reported treatment outcomes in children with one or more relapses of acute lymphoblastic leukemia (ALL). Authors reported complete remission (no sign of disease) rates of about 40% after the second relapse or later.

ALL is a type of cancer in which the bone marrow makes too many lymphoblasts (a type of immature white blood cell). It is the most common type of childhood cancer. While remission is often reached in children with ALL after primary treatment, it has been estimated that about 20% relapse within 5 years. Relapsed ALL is associated with poorer outcomes. Alternative treatment options are often needed, because many patients stop responding to standard chemotherapy over time.

Stem cell transplantation is sometimes recommended as part of treatment for ALL that has relapsed. This is a process in which healthy stem cells (immature cells) are reintroduced into an ALL patient, which helps in the production of new red or white blood cells. However, the benefit of a stem cell transplant for patients with multiple relapses has not been fully studied.

This study examined treatment outcomes in children with one or more ALL relapses.

The records of 225 children with relapsed ALL were analyzed. All children had experienced at least one prior relapse. Patients were then treated with re-induction therapy (treatment attempt with the aim to achieve another remission).

The complete remission rate after the first re-induction therapy was 83%. It was less than 50% after two or more re-induction therapy attempts. The duration of the first remission (before the first relapse occurred) was a predictor of relapse, particularly for later re-induction therapy attempts.

40% of patients after their second therapy attempt were disease-free at 2 years. This was 31% for patients after their third therapy attempt. At 5 years, this was 27% for patients after the second attempt and 15% for patients after the third attempt.

93% of patients underwent a stem cell transplant within 6 months of achieving remission after re-induction therapy. The average time from remission to transplant was 2.9 months. Patients undergoing a stem cell transplant were associated with a 58% survival improvement. This was unaffected by time to relapse or the number of previous relapses.

Authors reported complete remission rates of about 40% after the second relapse or later.