Long‐term follow‐up of relapsed childhood acute lymphoblastic leukaemia

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Abstract
Summary. We have reviewed the outcome after relapse in a cohort of 505 children with acute lymphoblastic leukaemia (ALL) seen at a single institution. The majority of relapses (74%) occurred within 3 years from diagnosis, and most involved the bone marrow alone or with overt extramedullary relapse. Early relapse was more common in children with T‐ALL and those with unfavourable cytogenetics. Factors influencing second remission included length of first remission and type of relapse. Children who had not received previous cranial irradiation had a superior survival. The German relapse score involving length of first remission, site of relapse and immunophenotype was highly predictive of outcome: event‐free survival with 95% confidence intervals at 6 years for patients who received modern treatment [intensive chemotherapy or bone marrow transplantation (BMT)] was 78% (51–92%) for standard risk, 41% (33–49%) for intermediate risk and 19% (10–31%) for highest risk. Retrospective comparison of BMT with chemotherapy showed no difference in the intermediate‐risk group but a possible advantage in the highest risk group. Follow‐up of 235 patients who relapsed after chemotherapy and received a third course of treatment showed an extremely high early attrition rate, but a small number of patients survived in third remission. We conclude that new approaches are needed to individualize therapy in intermediate‐risk patients and to improve the outcome for those in the highest risk group. Only a small number of children can be treated effectively in third remission.

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