Improved outcome for acute lymphoblastic leukemia in children and adolescents: Results of the MCP841 (Multicentre Protocol): A 20 years’ report from a developing country, India

Anita Chandra, Sagar G. Tenali, Devarajan Sriraman

Research output: Contribution to conferencePoster

Abstract

Background: In the 1970s, survival rates after treatment for acute lymphoblastic leukaemia (ALL) in children
and young adults (less than 25 years) in India were poor. The introduction of a standard treatment protocol
(MCP841) and improvements in supportive care led to an increase in the event-free survival rate (EFS) from less
than 20% to 45-50% at 4 years. Results of treatment with protocol MCP841 between 1983 and 2002 have been
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briefl y reviewed here. The MCP 841 reports the fi rst prospective, nonrandomized trial for acute lymphoblastic
leukemia (ALL), in collaboration with NCI, Bethesda, US. The aim of this study was to classify immunophenotypes, to analyze clinical features and laboratory features, and to assess whether this protocol would improve
the survival rate.
Patients and Materials: From January 1983 to December 2002, 566 children and adolescent (0-25 years) were
diagnosed with ALL in a regional cancer center in South India and were treated on MCP841 protocol with
intensive induction therapy, central nervous system directed therapy (cranial irradiation and intrathecal
methotrexate), and maintenance treatment for two years.
Results: From 1983 – 1989, 171 patients were enrolled in the protocol, and achieved a complete remission rate
of 74.8% with 25.1% induction deaths and 47.6% of patients relapsing after remission. During 1989-2002 with
improvement in supportive care 395 patients were enrolled. Three hundred and twenty eight (83%) of the
patients achieved complete remission, 45 failed to respond and 59 (11.9%) had treatment-related or disease related deaths before completing induction therapy. The overall 5-year event-free survival (EFS) rate was 38.3%.
The 5-year RFS rate was 44.5%. Relapse was noted in 147 of the 328 patients (44.8%). The cumulative incidence
of central nervous system (CNS) relapse was low. Age and white blood cell counts are strongly associated with
outcome in Western series, but were not a risk factor for EFS. At univariate and multivariate analysis the most
signifi cant determinant of a positive outcome was the achievement of complete remission. Comparison of
patient characteristics with published series from Western nations indicated that patients had more extensive
disease at presentation, as measured by WBC, lymphadenopathy and organomegaly. The proportion of patients with a precursor T-cell immunophenotype, was also increased.
Conclusion: Our strategy to adapt treatment to our population of patients was effective in improving the EFS.
It cannot be assumed that risk factors defi ned in Western populations are equally appropriate for patient assignment to risk-adapted therapy groups in less affl uent countries. They also demonstrate that heterogeneity
in patient populations and resources can result in signifi cant differences in outcome.
Original languageEnglish
Publication statusPublished - 2005
EventInternational Network on Cancer Treatment and Research: Annual Meeting - CHENNAI, CHENNAI, India
Duration: 10 Dec 200513 Dec 2005

Conference

ConferenceInternational Network on Cancer Treatment and Research
Abbreviated titleINCTR
CountryIndia
CityCHENNAI
Period10/12/0513/12/05

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    Chandra, A., Tenali, S. G., & Sriraman, D. (2005). Improved outcome for acute lymphoblastic leukemia in children and adolescents: Results of the MCP841 (Multicentre Protocol): A 20 years’ report from a developing country, India. Poster session presented at International Network on Cancer Treatment and Research, CHENNAI, India.