IS HIGH-DOSE METHOTREXATE WITHOUT IRRADIATION OF THE BRAIN SUFFICIENTLY EFFECTIVE IN PREVENTION OF CNS DISEASE IN CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA

We present 5-year results of treatment in 93 children suffering from a cute lymphoblastic leukemia using two therapeutic protocols containing multidrug chemotherapy including high dose methotrexate. We could asc ertain different results in standard and high risk patients. In a grou p of 62 children with standard risk we observed improvement in complet e remission rate being 98.9% after induction phase of therapy, only on e patient died on septicemia. Relapse rate in this group was 21.2% and that 14.7% in the bone marrow and 6.5% in CNS and no testicular relap se at all. In the group of 31 children with high risk leukemia all pat ients achieved complete remission. Only one of them died on acute panc reatitis due to toxicity. Overall relapse fate in this group was 28.9% with 12.8% of medullary relapse and 16.1% of CNS relapse. The last on e was significantly higher than in the previous study when brain irrad iation was a part of therapeutic procedure. It seems that this treatme nt is effective mainly in the standard risk leukemia, however, in the high risk leukemias this procedure appears to be less effective in pre venting CNS leukemia In this group of patients irradiation of the brai n need to be enclosed in the therapy.