Recurrent Childhood Lymphocytic Leukemia: Outcome of Marrow Relapses After Cessation of Therapy

Abstract

Leukemia therapists have long agreed that relapse — particularly in the bone marrow — signals the end of opportunities to obtain long-lasting remissions. This thinking can be traced to the emergence of drug-resistant lymphoblasts, the hallmark of leukemia in relapse, and to the lack of sufficient numbers of uniformly treated patients for analysis and comparison. It is becoming clear, however, that in patients with recurrent acute lymphocytic leukemia (ALL), treatment responses differ widely. Second hematologic remissions, for instance, are significantly longer in children who relapse after therapy is electively stopped than in those who relapse during therapy (Chessells and Cornbleet 1979; Ekert et al. 1979: Kearney et al. 1979: Rivera et al. 1976, 1978). Furthermore, in some patients, treatment can be stopped altogether for a second time with the possibility of continued diseasefree survival (Rivera et al. 1979). The purpose of this article is to review the clinical course of 56 patients who were retreated for marrow relapses that developed after cessation of intensive initial treatment.

Supported by Cancer Center Support (CORE) Grant CA-21765, by Leukemia Program Project Grant CA-20180, and by ALSAC