Research Article

Outcome of childhood acute lymphoblastic leukemia with induction failure treated by the Japan Association of Childhood Leukemia Study (JACLS) ALL F-protocol

  1. Nobuhiro Suzuki MD, PhD1,*,
  2. Keiko Yumura-Yagi MD, PhD2,
  3. Makoto Yoshida MD, PhD3,
  4. Junichi Hara MD, PhD4,
  5. Shinichiro Nishimura MD, PhD5,
  6. Tooru Kudoh MD, PhD6,
  7. Akio Tawa MD, PhD7,
  8. Ikuya Usami MD, PhD8,
  9. Akihiko Tanizawa MD, PhD9,
  10. Hiroki Hori MD, PhD10,
  11. Yasuhiko Ito MD, PhD11,
  12. Ryosuke Miyaji MD, PhD12,
  13. Megumi Oda MD, PhD13,
  14. Koji Kato MD, PhD14,
  15. Kazuko Hamamoto MD, PhD15,
  16. Yuko Osugi MD, PhD4,
  17. Yoshiko Hashii MD, PhD16,
  18. Tatsutoshi Nakahata MD, PhD17,
  19. Keizo Horibe MD, PhD18

Article first published online: 7 OCT 2009

DOI: 10.1002/pbc.22217

Issue

Pediatric Blood & Cancer

Pediatric Blood & Cancer

Volume 54, Issue 1, pages 71–78, January 2010

Additional Information

How to Cite

Suzuki, N., Yumura-Yagi, K., Yoshida, M., Hara, J., Nishimura, S., Kudoh, T., Tawa, A., Usami, I., Tanizawa, A., Hori, H., Ito, Y., Miyaji, R., Oda, M., Kato, K., Hamamoto, K., Osugi, Y., Hashii, Y., Nakahata, T. and Horibe, K. (2010), Outcome of childhood acute lymphoblastic leukemia with induction failure treated by the Japan Association of Childhood Leukemia Study (JACLS) ALL F-protocol. Pediatric Blood & Cancer, 54: 71–78. doi: 10.1002/pbc.22217

Author Information

  1. 1

    Department of Pediatrics, Sapporo Medical University Hospital, Sapporo, Japan

  2. 2

    Department of Pediatrics, Osaka General Medical Center, Osaka, Japan

  3. 3

    Department of Pediatrics, Asahikawa Medical College Hospital, Asahikawa, Japan

  4. 4

    Department of Pediatrics, Osaka City General Hospital, Osaka, Japan

  5. 5

    Department of Pediatrics, Hiroshima University Hospital, Hiroshima, Japan

  6. 6

    Department of Pediatrics, Hokkaido Medical center for Child Health and Rehabilitation, Sapporo, Japan

  7. 7

    Department of Pediatrics, National Hospital Organization Osaka National Hospital, Osaka, Japan

  8. 8

    Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan

  9. 9

    Department of Pediatrics, University of Fukui Faculty of Medical Sciences, University Hospital, Matsuoka, Fukui, Japan

  10. 10

    Department of Pediatrics, Mie University Hospital, Tsu, Japan

  11. 11

    Department of Pediatrics, Nagoya City University Hospital, Nagoya, Japan

  12. 12

    Department of Pediatrics, University of Occupational and Environmental Health Hospital, Kitakyushu, Japan

  13. 13

    Department of Pediatrics, Okayama University Hospital, Okayama, Japan

  14. 14

    Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

  15. 15

    Department of Pediatrics, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan

  16. 16

    Department of Pediatrics, Osaka University Hospital, Suita, Japan

  17. 17

    Department of Pediatrics, Kyoto University Hospital, Kyoto, Japan

  18. 18

    Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan

*Department of Pediatrics, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo 060-8543, Japan.

Publication History

  1. Issue published online: 9 NOV 2009
  2. Article first published online: 7 OCT 2009
  3. Manuscript Accepted: 29 JUN 2009
  4. Manuscript Received: 27 JAN 2009

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Keywords:

  • acute lymphoblastic leukemia;
  • chemotherapy;
  • childhood;
  • hematopoietic cell transplantation;
  • induction failure

Abstract

Background

Children with acute lymphoblastic leukemia (ALL) who fail to achieve complete remission (CR) after induction therapy (induction failure: IF) have a poor prognosis; however, there have been few prospective studies in patients with IF.

Patients and Methods

Between April 1997 and March 2005, 27 of 1,237 leukemic patients (2.2%) failed to achieve CR after four- or five-drug induction therapy. Twenty-three of these patients entered the F-protocol study, which mainly consisted of acute-myeloid-leukemia-oriented chemotherapy followed by scheduled hematopoietic cell transplantation (HCT).

Results

Seventeen (73.9%) of the 23 patients responded to re-induction chemotherapy with CR. Of note, 15 (93.8%) of 16 patients with Philadelphia-chromosome-negative (non-Ph+) ALL achieved CR; in contrast, only 2 (28.6%) of 7 Ph+ patients achieved CR. Fourteen (82.4%) of 17 patients remained in CR (CCR) until their scheduled HCT, 12 of the 14 with CCR underwent HCT as scheduled, and 6 patients remain in first CR after a median of 78 months (range, 49–107 months). The 5-year overall survival (OS) rates of 16 patients with non-Ph+ and 7 patients with Ph+ were 43.8 ± 12.4% and 14.3 ± 13.2%, respectively (P = 0.012). The 5-year OS rate of the 17 patients who obtained CR by re-induction therapy and the 6 who did not were 47.1 ± 12.1% and 0%, respectively (P < 0.001).

Conclusion

Acute-myeloid-leukemia-oriented chemotherapy followed by scheduled HCT is a promising treatment strategy for non-Ph+ ALL patients with IF. Pediatr Blood Cancer 2010; 54:71–78. © 2009 Wiley-Liss, Inc.

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