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