SURVIVAL AND ENDOCRINE OUTCOME AFTER TESTICULAR RELAPSE IN ACUTE LYMPHOBLASTIC-LEUKEMIA

Survival and endocrine status in a cohort of boys with acute lymphobla stic leukaemia (ALL) who started treatment between 1972 and 1987 and s ubsequently developed a testicular relapse were analysed. During this period there was a significant improvement in the overall event free s urvival for boys, but no significant decrease in the testicular relaps e rate. Thirty three boys had an apparently isolated testicular relaps e, whereas 21 boys had a combined relapse. The event free survival for boys with an isolated testicular relapse was 59% at six years (95% co nfidence interval (CI) 42 to 74%). The event free survival for the 16 patients with a combined relapse who received a second course of treat ment was 32% (95% CI 17 to 60%). Those patients receiving adequate sec ond line treatment for an isolated testicular relapse whose first remi ssion was longer than or equal to two years had an event free survival of 82% (95% CI 63 to 93%) at six years. No boy relapsing within two y ears from diagnosis has survived. Endocrine late effects are significa nt, with 82% of the boys requiring hormonal treatment at some stage fo r induction of puberty or continuing pubertal maturation, or both. It is concluded that, despite the increasing intensity of initial treatme nt for ALL, isolated testicular relapse is treatable by conventional m eans in most patients. Careful endocrine follow up of these patients i s essential as most will require hormone replacement treatment.