Early response to treatment has been shown to be an
important prognostic factor of childhood acute lymphoblastic leukemia (ALL)
patients in Western studies. We studied this factor in the setting of a
low-income province in 165 patients treated on Indonesian WK-ALL-2000 protocol
between 1999 and 2006. Poor early response, defined as a peripheral
lymphoblasts count of ≥1000/µL after 7 days of oral dexamethasone plus one
intrathecal methotrexate (MTX), occurred in 19.4% of the patients. Poor
responders showed a higher probability of induction failures compared to good
responders (53.1% versus 23.3%, P < 0.01), higher probability of resistant
disease (15.6% versus 4.5%, P = 0.02), shorter disease-free survival (P =
0.034; 5-year DFS: 24.9% ± 12.1% versus 48.6% ± 5.7%), and shorter event-free
survival (P = 0.002; 5-year EFS: 9.7% ± 5.3% versus 26.3% ± 3.8%). We observed
that the percentage of poor responders in our setting was higher than reported
for Western countries with prednisone or prednisolone as the steroids. The
study did not demonstrate a significant additive prognostic value of early
response over other known risk factors (age and white blood cell count) for DFS
and only a moderately added value for EFS.
Author(s) Details Pudjo H. Widjajanto
Pediatric Hematology and Oncology Division, Department of Pediatrics, Dr. Sardjito Hospital/ Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Sutaryo Sutaryo
Pediatric Hematology and Oncology Division, Department of Pediatrics, Dr. Sardjito Hospital/ Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Ignatius Purwanto
Pediatric Hematology and Oncology Division, Department of Pediatrics, Dr. Sardjito Hospital/ Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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