A 2ND COURSE OF TREATMENT FOR CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA - LONG-TERM FOLLOW-UP IS NEEDED TO ASSESS RESULTS

We report the results of long-term follow-up of 94 children who comple ted treatment for acute lymphoblastic leukaemia (ALL) between 1974 and 1986 and subsequently experienced a bone marrow relapse before 1992. 91 children received further induction, intensification and CNS direct ed therapy; 19 proceeded to BMT or ABMT and the remainder were treated on one of three protocols which increased in intensity. The duration of second remission improved significantly with increasing intensity o f treatment and bone marrow transplantion was followed by fewer relaps es than chemotherapy. Analysis of factors influencing the duration of second remission showed that only length of first remission was of add itional significance; the median duration of second remission being on ly 19 months in children with a first remission of less than 4 years a nd 62 months in those with longer first remissions. 29 children electi vely stopped chemotherapy a second time but only 11 of these remain st ill in second remission with recurrences occurring for up to 7 years f rom the the time first relapse. Only three of the 24 long-term survivo rs had no significant late effects of treatment; these were most marke d in children who had received a second course of radiotherapy. We con clude that very long follow-up is necessary to determine whether patie nts may be successfully re-treated following late bone marrow relapse and that all such treatment is associated with a high incidence of lat e effects.