| Abstract: | Current therapy for childhood ALL is effective and certainly much better than what was available 10 years ago. According to our protocol 721, 745, and 765 studies, between 40% and 60% of children with ALL are now on long-term survival, even after discontinuation of the therapy for several years. However, results are not nearly as good in patients who have identifiable poor risk features. A review of 162 patients with ALL was undertaken to determine the important factors, other than therapy, influencing survival. Childhood ALL can be divided into two groups according to major prognostic factors such as age and initial leukocyte counts; Group I -standard risk group and Group II -high risk group. To minimize side effects while trying to improve further efficacy of therapy and to prevent late relapse, our new protocol 811 has been initiated for standard risk patients of ALL. The more aggressive use of current agents such as methotrexate and adriamycin to prevent early relapse has been applied for high risk patients of ALL. The preliminary results of protocol 811 showed that early intensification with high-dose methotrexate and adriamycin seemed to prolong the remission duration of high risk ALL, but further long follow-up study is needed. With considerable progress being made toward the cure of childhood leukemias, the issue of late effects assumes increasing importance. The next generation of treatment studies, in addition to further attempts at improving the proportion of survivors, will need to develop strategies aimed at clearly defining and minimizing these late sequelae. |
