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Slovenska pediatrija 2011; 18: 239-249

https://doi.org/

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Research article

TREATMENT OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKAEMIA IN SLOVENIA

S. Avčin
Klinični oddelek za hematologijo in onkologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

T. Prelog
Klinični oddelek za hematologijo in onkologijo, Pediatrična klinika Ljubljana, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

M. Kavčič
Klinični oddelek za hematologijo in onkologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

L. Kitanovski
Klinični oddelek za hematologijo in onkologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana

J. Anžič
Klinični oddelek za otroško onkologijo in hematologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija (v pokoju od 2009)

M. Benedik Dolničar
Klinični oddelek za hematologijo in onkologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

V. Rajić
Klinični oddelek za otroško hematologijo in onkologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

L. Zadravec Zaletel
Oddelek za radioterapijo, Onkološki inštitut, Ljubljana, Slovenija

M. Debeljak
Klinični oddelek za hematologijo in onkologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

J. Jazbec
Klinični oddelek za hematologijo in onkologijo, Pediatrična klinika Ljubljana, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

Abstract

Between 1967and 2004, 394 patients (pts) were treated for acute lymphoblastic leukaemia (ALL) in the Haematology and Oncology Department of the Children’s Hospital in Ljubljana, Slovenia, using six different therapeutic protocols. Survival and long- term outcome in these children and adolescents were evaluated with regard to differences in treatment protocols, which evolved over time. During the above period marked progress was achieved in the treatment of patients with ALL, resulting in decreased mortality and less relapses and secondary neoplasms. This was mainly due to the inclusion of patients in randomised multicentre studies in which the patients were divided je uniform criteria and treated using uniform protocols. The presented results from our Centre are comparable to those of other European centres that used similar treatment protocols. Retrospectively, the 5-year overall survival ± standard deviation (5yOS), relapse rate (RR) and the rate of second neoplasm (SN) were estimated according to the treatment protocol, age, and where recorded, also according to the BFM risk group, white blood cell count and disease subtype. For treatment protocols used after 1992, the 5-year event-free survival ± standard deviation (5yEFS) was added to our observations. Among the 75 pts enrolled in the pre-POG treatment protocol, the probability of 5yOS was 25.3±5.0%, while no data for RR and SN analysis were available. For 91 pts treated according to the POG protocol, the probability of 5yOS was 61.6±5.1%, with a 64% RR and 5.5% occurrence of SN. A probability of 5yOS of 74.3±7.4%, a RR of 37% and 8.5% occurrence of SN were achieved for 35 pts enrolled in the ALL-BFM 83 protocol. The ALL-BFM 86 protocol, which included 62 pts, resulted in a 69.4±5.9% probability of 5yOS, a 33% RR and 3.2% occurrence of SN. For the ALL-BFM 90 protocol, the 5yEFS and 5yOS for 71 pts was 77.3±5.2% and 81.8±4.8%, respectively, with a 17% RR and 1.5% occurrence of SN. 56 pts enrolled in the ALL-BFM 95 protocol achieved 83.0±5.2% 5yEFS and 92.6±3.6% 5yOS, with a 16% RR and 1.7% occurrence of SN. A stepwise rise in the OS, a decline in RR and SN and, for the ALL-BFM 90 and ALL-BFM 95 protocols, improvement in EFS, were observed over time with the introduction of different treatment protocols. General improvement in OS, RR and the occurrence of SN was most obvious after the introduction of the BFM protocol, with evident a continuous rise in OS and decline in RR and the occurrence of SN thereafter.

Key words: acute lymphoblastic leukaemia, treatment, survival, single centre experience.