ACUTE LYMPHOBLASTIC-LEUKEMIA IN INFANCY - EXPERIENCE IN MRC UKALL TRIALS - REPORT FROM THE SEARCH-COUNCIL-WORKING-PARTY-ON-CHILDHOOD-LEUKEMIA

Acute lymphoblastic leukaemia (ALL) is rare under 1 year and has a poo r prognosis. Only 14 of 48 infants treated on two consecutive MRC UKAL L trials remain alive in first remission. Forty infants have subsequen tly been treated on a protocol incorporating further intensification w ith an option for high-dose chemotherapy and autologous or allogeneic bone marrow transplantation. The results show no improvement over prev ious trials largely due to the number of remission deaths; four of nin e being associated with toxicity of 5 days of etoposide and cytarabine . Only three of II children treated by high-dose chemotherapy and tran splantation remain alive in remission. Multivariate analysis of the fa ctors influencing prognosis in all 88 infants showed that only age was significant. Event-free survival was 40% at 5 years for children over 26 weeks but under 10% for younger children. These results show the s usceptibility of infants to the toxicity of intensive chemotherapy and do not support the use of short term high-dose chemotherapy alone in the management of infant leukaemia. Despite the unique biological feat ures of infant ALL it appears that these patients also may benefit fro m longer courses of treatment with a maintenance (continuing) phase.