Testicular infiltrates in children with acute lymphoblastic leukemia: A prospective study

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Abstract
The incidence of testicular infiltrates in 68 boys with acute lymphoblastic leukemia in first remission (1974-81), was prospectively investigated through careful clinical examination and routine bilateral biopsies at 2-3 years of remission. All boys were under 14 years of age and they were treated with protocols D.74 and Pethema 7/78. Seven patients (10.3%) presented an isolated testicular relapse (ITR) during the chemotherapy period. In 13 of the 43 testicular biopsies (31%) leukemic infiltrates were found, and in another two findings were controversial. Three boys, two with previous negative biopsies, had an ITR 6 to 18 months after therapy was stopped. Finally, three others had simultaneous relapses in testes and bone marrow, one during chemotherapy and two after suppression. In all, 23 patients (33.8%) in first remission had overt or occult ITR. Overall estimated incidence rate of testes leukemia is 40% in all the groups. Incidence of early and occult ITR was higher in boys with initial WBC counts over 20 × 109/1. Therapy in ITR generally consisted of local radiotherapy (20-25 Gy), a new induction treatment followed by 2-year maintenance treatment; in three patients with early ITR, orchidectomy was also performed and six were given a new CNS preventive treatment. Clinical course in the seven patients with early ITR was unfavourable in five, with subsequent hematological relapses and death; one had a long-term disease-free survival (80 + months) and the other was a recent case. Ten of the 13 patients with occult infiltrates continued in remission and four were off treatment with a follow-up of over 66 months. The three patients with late ITR were in 2nd remission at 8-18 months after a new cessation of therapy. It may be concluded from this study that prognosis in ITR is related to the phase of presentation: it is unfavourable in cases of early ITR, but in occult infiltrates, detected by routine biopsy, and in late ITR combined therapy is effective in most cases.