Treatment of childhood acute lymphoblastic leukemia in Jakarta: Result of modified Indonesian National Protocol 94
Background Before 1990, the survival rates of childhood acute lymphoblastic leukemia (ALL) patients remained low. In 1994, the Hematology Oncology Working Group of the Indonesian Pediatric Association constructed a national protocol based on standard in- ternational protocol. As the outcome was stil...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Indonesian Pediatric Society Publishing House
2016-10-01
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| Series: | Paediatrica Indonesiana |
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| Online Access: | https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/925 |
| _version_ | 1819204970295066624 |
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| author | Djajadiman Gatot Endang Windiastuti |
| author_facet | Djajadiman Gatot Endang Windiastuti |
| author_sort | Djajadiman Gatot |
| collection | DOAJ |
| description | Background Before 1990, the survival rates of childhood acute
lymphoblastic leukemia (ALL) patients remained low. In 1994, the
Hematology Oncology Working Group of the Indonesian Pediatric
Association constructed a national protocol based on standard in-
ternational protocol. As the outcome was still not promising, in 1998
the protocol was modified by introducing low dose MTX infusion for
CNS prophylaxis.
Objective To analyze the survival of pediatric ALL patient treated with
the modified protocol in Cipto Mangunkusumo Hospital, Jakarta.
Methods A prospective study was carried out to all newly diag-
nosed and relapsed children with ALL from January 1998 through
December 2004. Patients were stratified into standard risk group
(SRG) and high risk group (HRG). HRG met with one of these
criteria: WBC >50 000/ìl, the presence of CNS involvement, medi-
astinal mass, relapse, or L 3 morphology. After completing induc-
tion therapy, all patients received low-dose MTX (LDMTX) infusion
(500 mg/m 2 ), especially for those aged less than 3 years. If the
patient could not afford LDMTX, cranial irradiation (CRT) was given.
Results There were 309 patients, consisted of 190 SRG and 119 HRG
patients. Male to female ratio was 1.8:1. Complete remission was
achieved in 86.3% SRG patients compared with 63.8% in HRG pa-
tients (P<0.05). Event-free survival (EFS) rate in SRG and HRG were
65.9% (95%CI 59.8; 71.9%) and 40.4% (95%CI 32.5; 48.4%), respec-
tively. The overall survival (OS) rates in SRG was 81.2% (95%CI 76.3;
86.2%) and in HRG was 56.0% (95%CI 47.8; 64.2%). The overall OS
and EFS for both groups were 71.6% (95%CI 67.0; 76.2%) and 59.6%
(95%CI 54.5; 64.7%), respectively. Failure of therapy was mostly due
to severe aplasia resulted in bleeding and severe infection. CNS re-
lapse was rare in both groups, i.e. 3.1% in SRG and 0.8% in HRG.
Conclusion Treatment of ALL using modified national protocol for
SRG shows promising results. However, the outcome of HRG pa-
tients is still inferior to those reported elsewhere. The use of low-
dose MTX infusion can replace the role of cranial irradiation as
CNS prophylaxis measure. |
| first_indexed | 2024-12-23T04:44:16Z |
| format | Article |
| id | doaj.art-e3a407cf794f43329b76e346aadc0be8 |
| institution | Directory Open Access Journal |
| issn | 0030-9311 2338-476X |
| language | English |
| last_indexed | 2024-12-23T04:44:16Z |
| publishDate | 2016-10-01 |
| publisher | Indonesian Pediatric Society Publishing House |
| record_format | Article |
| series | Paediatrica Indonesiana |
| spelling | doaj.art-e3a407cf794f43329b76e346aadc0be82022-12-21T17:59:42ZengIndonesian Pediatric Society Publishing HousePaediatrica Indonesiana0030-93112338-476X2016-10-014641798410.14238/pi46.4.2006.179-84781Treatment of childhood acute lymphoblastic leukemia in Jakarta: Result of modified Indonesian National Protocol 94Djajadiman GatotEndang WindiastutiBackground Before 1990, the survival rates of childhood acute lymphoblastic leukemia (ALL) patients remained low. In 1994, the Hematology Oncology Working Group of the Indonesian Pediatric Association constructed a national protocol based on standard in- ternational protocol. As the outcome was still not promising, in 1998 the protocol was modified by introducing low dose MTX infusion for CNS prophylaxis. Objective To analyze the survival of pediatric ALL patient treated with the modified protocol in Cipto Mangunkusumo Hospital, Jakarta. Methods A prospective study was carried out to all newly diag- nosed and relapsed children with ALL from January 1998 through December 2004. Patients were stratified into standard risk group (SRG) and high risk group (HRG). HRG met with one of these criteria: WBC >50 000/ìl, the presence of CNS involvement, medi- astinal mass, relapse, or L 3 morphology. After completing induc- tion therapy, all patients received low-dose MTX (LDMTX) infusion (500 mg/m 2 ), especially for those aged less than 3 years. If the patient could not afford LDMTX, cranial irradiation (CRT) was given. Results There were 309 patients, consisted of 190 SRG and 119 HRG patients. Male to female ratio was 1.8:1. Complete remission was achieved in 86.3% SRG patients compared with 63.8% in HRG pa- tients (P<0.05). Event-free survival (EFS) rate in SRG and HRG were 65.9% (95%CI 59.8; 71.9%) and 40.4% (95%CI 32.5; 48.4%), respec- tively. The overall survival (OS) rates in SRG was 81.2% (95%CI 76.3; 86.2%) and in HRG was 56.0% (95%CI 47.8; 64.2%). The overall OS and EFS for both groups were 71.6% (95%CI 67.0; 76.2%) and 59.6% (95%CI 54.5; 64.7%), respectively. Failure of therapy was mostly due to severe aplasia resulted in bleeding and severe infection. CNS re- lapse was rare in both groups, i.e. 3.1% in SRG and 0.8% in HRG. Conclusion Treatment of ALL using modified national protocol for SRG shows promising results. However, the outcome of HRG pa- tients is still inferior to those reported elsewhere. The use of low- dose MTX infusion can replace the role of cranial irradiation as CNS prophylaxis measure.https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/925acute lymphoblastic leukemiachildhoodsurvival |
| spellingShingle | Djajadiman Gatot Endang Windiastuti Treatment of childhood acute lymphoblastic leukemia in Jakarta: Result of modified Indonesian National Protocol 94 Paediatrica Indonesiana acute lymphoblastic leukemia childhood survival |
| title | Treatment of childhood acute lymphoblastic leukemia in Jakarta: Result of modified Indonesian National Protocol 94 |
| title_full | Treatment of childhood acute lymphoblastic leukemia in Jakarta: Result of modified Indonesian National Protocol 94 |
| title_fullStr | Treatment of childhood acute lymphoblastic leukemia in Jakarta: Result of modified Indonesian National Protocol 94 |
| title_full_unstemmed | Treatment of childhood acute lymphoblastic leukemia in Jakarta: Result of modified Indonesian National Protocol 94 |
| title_short | Treatment of childhood acute lymphoblastic leukemia in Jakarta: Result of modified Indonesian National Protocol 94 |
| title_sort | treatment of childhood acute lymphoblastic leukemia in jakarta result of modified indonesian national protocol 94 |
| topic | acute lymphoblastic leukemia childhood survival |
| url | https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/925 |
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