Outcome of very late relapse in children with acute lymphoblastic leukemia

Carmelo Rizzari, Maria Grazia Valsecchi, Maurizio Arico, Roberto Miniero, Chiara Messina, Giulio De Rossi, Anna Maria Testi, Rossella Mura, Stefania Galimberti, Andrea Biondi, Franco Locatelli, Valentino Conter

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Abstract

Introduction and Objectives. Few data are available on the long-term outcome of children who present with a very late relapse of acute lymphoblastic leukemia, so treatment of these patients remains controversial. The present study was aimed at investigating clinical features and treatment outcome of children with very late relapse, diagnosed and treated in Italy in the last 20 years. Design and Methods. All children diagnosed in Italian centers with a first relapse of acute lymphoblastic leukemia occurring ≥ 60 months after attainment of first complete remission were included in this study. These relapses were diagnosed between 1982 and 1997. Results. Ninety-three patients (58 males, 62.4%) had a first very late relapse occurring at a median time of 6.1 years (range 5.8-13.7 years) after the initial diagnosis. At a median follow-up time of 9.1 years after relapse, the overall 5-year survival (SE) and event-free-survival (SE) were 55.6% (5.2) and 39.5% (5.1), respectively. In multivariate analysis the site of relapse was the only significant predictor of duration of the second complete remission. Patients with isolated bone marrow relapse fared worse than those with combined or isolated extramedullary relapse [5-year event-free survival (SE) 24.5% (5.9), 51.3% (11.1) and 68.4% (10.7), respectively; (p=0.004)]. All 7 patients who underwent an allogeneic bone marrow transplantation from a matched related donor are alive in second complete remission. Interpretation and Conclusions. In this evaluation patients with a very late relapse isolated to the bone marrow had a poor outcome while re-treatment of extramedullary or combined relapse was associated with better cure rate. Our data suggest that patients with very late isolated bone marrow relapse should be treated intensively; bone marrow transplantation from a matched related donor may be indicated.

Original languageEnglish
Pages (from-to)427-434
Number of pages8
JournalHaematologica
Volume89
Issue number4
Publication statusPublished - Apr 2004

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Recurrence
Bone Marrow
Bone Marrow Transplantation
Disease-Free Survival
Tissue Donors
Homologous Transplantation
Italy
Multivariate Analysis

Keywords

  • Acute lymphoblastic leukemia
  • Childhood
  • Relapse
  • Treatment

ASJC Scopus subject areas

  • Hematology

Cite this

Rizzari, C., Valsecchi, M. G., Arico, M., Miniero, R., Messina, C., De Rossi, G., ... Conter, V. (2004). Outcome of very late relapse in children with acute lymphoblastic leukemia. Haematologica, 89(4), 427-434.

Outcome of very late relapse in children with acute lymphoblastic leukemia. / Rizzari, Carmelo; Valsecchi, Maria Grazia; Arico, Maurizio; Miniero, Roberto; Messina, Chiara; De Rossi, Giulio; Testi, Anna Maria; Mura, Rossella; Galimberti, Stefania; Biondi, Andrea; Locatelli, Franco; Conter, Valentino.

In: Haematologica, Vol. 89, No. 4, 04.2004, p. 427-434.

Research output: Contribution to journalArticle

Rizzari, C, Valsecchi, MG, Arico, M, Miniero, R, Messina, C, De Rossi, G, Testi, AM, Mura, R, Galimberti, S, Biondi, A, Locatelli, F & Conter, V 2004, 'Outcome of very late relapse in children with acute lymphoblastic leukemia', Haematologica, vol. 89, no. 4, pp. 427-434.
Rizzari C, Valsecchi MG, Arico M, Miniero R, Messina C, De Rossi G et al. Outcome of very late relapse in children with acute lymphoblastic leukemia. Haematologica. 2004 Apr;89(4):427-434.
Rizzari, Carmelo ; Valsecchi, Maria Grazia ; Arico, Maurizio ; Miniero, Roberto ; Messina, Chiara ; De Rossi, Giulio ; Testi, Anna Maria ; Mura, Rossella ; Galimberti, Stefania ; Biondi, Andrea ; Locatelli, Franco ; Conter, Valentino. / Outcome of very late relapse in children with acute lymphoblastic leukemia. In: Haematologica. 2004 ; Vol. 89, No. 4. pp. 427-434.
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abstract = "Introduction and Objectives. Few data are available on the long-term outcome of children who present with a very late relapse of acute lymphoblastic leukemia, so treatment of these patients remains controversial. The present study was aimed at investigating clinical features and treatment outcome of children with very late relapse, diagnosed and treated in Italy in the last 20 years. Design and Methods. All children diagnosed in Italian centers with a first relapse of acute lymphoblastic leukemia occurring ≥ 60 months after attainment of first complete remission were included in this study. These relapses were diagnosed between 1982 and 1997. Results. Ninety-three patients (58 males, 62.4{\%}) had a first very late relapse occurring at a median time of 6.1 years (range 5.8-13.7 years) after the initial diagnosis. At a median follow-up time of 9.1 years after relapse, the overall 5-year survival (SE) and event-free-survival (SE) were 55.6{\%} (5.2) and 39.5{\%} (5.1), respectively. In multivariate analysis the site of relapse was the only significant predictor of duration of the second complete remission. Patients with isolated bone marrow relapse fared worse than those with combined or isolated extramedullary relapse [5-year event-free survival (SE) 24.5{\%} (5.9), 51.3{\%} (11.1) and 68.4{\%} (10.7), respectively; (p=0.004)]. All 7 patients who underwent an allogeneic bone marrow transplantation from a matched related donor are alive in second complete remission. Interpretation and Conclusions. In this evaluation patients with a very late relapse isolated to the bone marrow had a poor outcome while re-treatment of extramedullary or combined relapse was associated with better cure rate. Our data suggest that patients with very late isolated bone marrow relapse should be treated intensively; bone marrow transplantation from a matched related donor may be indicated.",
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AU - Rizzari, Carmelo

AU - Valsecchi, Maria Grazia

AU - Arico, Maurizio

AU - Miniero, Roberto

AU - Messina, Chiara

AU - De Rossi, Giulio

AU - Testi, Anna Maria

AU - Mura, Rossella

AU - Galimberti, Stefania

AU - Biondi, Andrea

AU - Locatelli, Franco

AU - Conter, Valentino

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N2 - Introduction and Objectives. Few data are available on the long-term outcome of children who present with a very late relapse of acute lymphoblastic leukemia, so treatment of these patients remains controversial. The present study was aimed at investigating clinical features and treatment outcome of children with very late relapse, diagnosed and treated in Italy in the last 20 years. Design and Methods. All children diagnosed in Italian centers with a first relapse of acute lymphoblastic leukemia occurring ≥ 60 months after attainment of first complete remission were included in this study. These relapses were diagnosed between 1982 and 1997. Results. Ninety-three patients (58 males, 62.4%) had a first very late relapse occurring at a median time of 6.1 years (range 5.8-13.7 years) after the initial diagnosis. At a median follow-up time of 9.1 years after relapse, the overall 5-year survival (SE) and event-free-survival (SE) were 55.6% (5.2) and 39.5% (5.1), respectively. In multivariate analysis the site of relapse was the only significant predictor of duration of the second complete remission. Patients with isolated bone marrow relapse fared worse than those with combined or isolated extramedullary relapse [5-year event-free survival (SE) 24.5% (5.9), 51.3% (11.1) and 68.4% (10.7), respectively; (p=0.004)]. All 7 patients who underwent an allogeneic bone marrow transplantation from a matched related donor are alive in second complete remission. Interpretation and Conclusions. In this evaluation patients with a very late relapse isolated to the bone marrow had a poor outcome while re-treatment of extramedullary or combined relapse was associated with better cure rate. Our data suggest that patients with very late isolated bone marrow relapse should be treated intensively; bone marrow transplantation from a matched related donor may be indicated.

AB - Introduction and Objectives. Few data are available on the long-term outcome of children who present with a very late relapse of acute lymphoblastic leukemia, so treatment of these patients remains controversial. The present study was aimed at investigating clinical features and treatment outcome of children with very late relapse, diagnosed and treated in Italy in the last 20 years. Design and Methods. All children diagnosed in Italian centers with a first relapse of acute lymphoblastic leukemia occurring ≥ 60 months after attainment of first complete remission were included in this study. These relapses were diagnosed between 1982 and 1997. Results. Ninety-three patients (58 males, 62.4%) had a first very late relapse occurring at a median time of 6.1 years (range 5.8-13.7 years) after the initial diagnosis. At a median follow-up time of 9.1 years after relapse, the overall 5-year survival (SE) and event-free-survival (SE) were 55.6% (5.2) and 39.5% (5.1), respectively. In multivariate analysis the site of relapse was the only significant predictor of duration of the second complete remission. Patients with isolated bone marrow relapse fared worse than those with combined or isolated extramedullary relapse [5-year event-free survival (SE) 24.5% (5.9), 51.3% (11.1) and 68.4% (10.7), respectively; (p=0.004)]. All 7 patients who underwent an allogeneic bone marrow transplantation from a matched related donor are alive in second complete remission. Interpretation and Conclusions. In this evaluation patients with a very late relapse isolated to the bone marrow had a poor outcome while re-treatment of extramedullary or combined relapse was associated with better cure rate. Our data suggest that patients with very late isolated bone marrow relapse should be treated intensively; bone marrow transplantation from a matched related donor may be indicated.

KW - Acute lymphoblastic leukemia

KW - Childhood

KW - Relapse

KW - Treatment

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