Toxicity, supportive care and costs of two chemotherapy protocols for treatment of childhood ALL in Russia: BFM 90m and MB 91

Since the late 1980s, polychemotherapy protocols for the treatment of child hood acute lymphoblastic leukaemia (ALL) derived from Western European and American regimens have been introduced in Russian paediatric oncology centr es. Whereas treatment results were significantly improved compared with the results of former non-standard treatment strategies, the substantial toxic ity of these protocols required a high standard of supportive care, and the high costs of treatment became a major problem. In 1991, a new protocol wa s developed with the aim of reducing toxicity and costs without affecting e fficacy of the treatment. Since 1991, a single-centre study comparing the n ew Russian Protocol, Moscow-Berlin 91 (IMB), with a modified version of the protocol ALL BFM 90 (BFM) of the Berlin-Frankfurt-Munster group was perfor med in Moscow to evaluate possible advantages of the new protocol under Rus sian conditions. The aim of the present analysis was to compare toxicity, n eed of supportive care and expense of both regimens (BFM, 25 pts; MB, 32 pt s). Hepatotoxicity (liver enzymes), nephrotoxicity (creatinine), duration o f neutropenia, and platelet transfusions were similar in both protocols. Th e median erythrocyte transfusion level was greater in the BFM (1000 ml/m(2) ) than the MB patients (505 ml/m(2), P<0.01), as was the length of intraven ous (i.v.) antibiotic therapy (22 days BFM versus 9 days MB, P<0.01), treat ment delays (39 days BFM versus 21 days MB, P<0.001), and duration of in-pa tient treatment (47 days BFM versus 18 days MB, P<0.001). Side-effects of t he MB protocol occurred mainly during induction therapy. Total costs (mean cost/person/m(2) body surface) of treatment including supportive care were 1.73-fold higher for the BFM protocol than MB, whereas costs of cytostatic drugs were comparable in both groups. In Russia both protocols were feasibl e. During consolidation therapy tolerance to treatment was better in MB 91 compared with BFM 90m, whereas toxicity during induction therapy was simila r in both protocols. With respect to costs and side-effects, the MB 91 prot ocol appears to be an alternative to established protocols for countries wi th limited financial and clinical resources. (C) 1999 Elsevier Science Ltd. All rights reserved.