INDUCTION TOXICITY OF A MODIFIED MEMORIAL-SLOAN-KETTERING-NEW-YORK IIPROTOCOL IN CHILDREN WITH RELAPSED ACUTE LYMPHOBLASTIC-LEUKEMIA - A SINGLE INSTITUTION STUDY

Although the chance of cure for children with acute lymphoblastic leuk aemia (ALL) is high, their outlook with subsequent relapse is poor. Bo ne marrow transplantation may be an option for some, but the need for intensive reinduction chemotherapy regimens remains the best hope for effecting cure in the majority of relapsed children. The authors repor t the experience of using an intensive chemotherapy protocol (Memorial Sloan-Kettering-New York II Protocol, MSK-NY-II) in a series of relap sed children with ALL. Thirty children presenting to the Royal Alexand ra Hospital for Children, Sydney, in their first relapse of ALL were t reated according to a modification of the original MSK-NY-II protocol. Three children (10%) died during induction therapy, two from overwhel ming Cram-negative sepsis, and one from intracerebral haemorrhage. Of 27 children completing induction, two children failed to enter remissi on; however, both had planned deviations from the protocol. Infectious complications were prominent with a total of 55 admissions for febril e neutropenic episodes. Eight children required the support of the int ensive care unit for infectious complications. A total of 36 microbiol ogical isolates were obtained from the patients during induction ther apy. Ten bone marrow transplant procedures have been subsequently perf ormed in these children, of whom five are alive and disease free at th e time of writing. The MSK-NY-II protocol is an intensive regimen but with encouraging early remission rates in relapsed childhood ALL. Earl y sepsis in previously immunosuppressed children is an important cause of induction death. (C) 1996 Wiley-Liss, Inc.