Analysis of Treatment in Childhood Leukaemia

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Abstract
The 1st and 2nd Medical Research Council UKALL trails showed that alteration in the timing of methotrexate and 6-mercaptopurine maintenance therapy for the treatment of acute lymphoblastic leukemia can markedly change drug induced toxicity. Maintenance chemotherapy in both trials used a similar total dosage of these drugs but the timing of their administration was different in the 2 schedules. Serial analysis of leukocyte count showed that the UKALL I regimen caused considerably more neutropenia than UKALL II but UKALL II was associated with prolonged lymphopenia which was not characteristic of UKALL I. Analysis of deaths in remission in these 2 trials showed some correlation with these findings. Deaths in complete remission were compared with the known prognostic features of age and presenting white cell count. Of the 350 patients achieving remission, 63% had the good prognostic features of being less than 13 yr of age and having a white cell count below 20 .times. 109/l at presentation. Twelve out of the 26 deaths in this group occurred in patients in 1st remission. In the remaining 128 patients who lacked one or both of these good prognostic features, only 1 out of 56 deaths recorded to date occurred during remission.