PUB-0185 Outcome of children with acute lymphoblastic leukemia (ALL) treated on a risk-stratified protocol (PALL08) based on local experience

Document Type





Purpose/Objective: To evaluate outcome of a protocol with risk-stratification based on results of our previous protocols and treatment strategy based on internationally published reports.
Materials and Methods: Prospectively collected data on 180 children with ALL treated atour institution on our PALL08 protocol from 2008 and 2012 were analyzed.
Results: Median age was 4.6 years (1.1-13.3, 5.5[1]0.24) and 58.3% were male. 160patients with B-ALL were categorized as low risk (LR) if within good-risk ranges for age and WBC count and if good-risk cytogenetics (hyperdiploidy or RUNX1-ETV6) were positive. Children with CNS3 status or with>5% blasts on Day 14 BM evaluation were considered very high risk (VHR). All others, including children with CNS2, were considered high risk (HR). Twenty patients with T-ALL were stratified according to WBC count and CNS positivity into LR (4) and HR (16). Forty-six (25.6%), 103 (57.2%) and 10 (5.6%) children with B-ALL were treated on LR, HR and VHR protocols. Two patients (1.1%) died during induction. 172 patients (95.6%) achieved complete remission at end of induction. Ten (5.8%) patients relapsed at a median of 12.1months (3.5-37, 15.6[1]3.8) from remission. With a median follow up period of 2.3[1]0.124 years the overall survival (OS) was 86.2%and event free survival (EFS) was 83.8% compared to 82.5% and 69.9% on our previous protocol (OS p=0.1 and EFS p=0.02). There was no difference in survival between T- and B-ALL (OS=85.5% v. 93.8% and EFS=84.5% v. 78.9%; p=NS). CNS3 status was associated with poor outcome (EFS=40%) while trisomy 4/10 (EFS=97.4%) andRUNX1-ETV6(EFS=96.3%) conferred good prognosis. Infectious toxicity continues to be high.
Conclusions: Although relapse rate on this protocol has decreased from our previous results (21.7%) longer term follow-up to look at relapse and toxicity outcomes is needed. Risk-stratified approach to ALL therapy based on local results is essential to improve outcomes.


This work was published before the author joined Aga Khan University

Publication ( Name of Journal)

Pediatric Blood & Cancer