Combination of chemotherapy, radiotherapy and immunotherapy for acute lymphoblastic leukemia in children
Suvatte, V.; Mahasandana, C.; Tanphaichitr, V.S.; Tuchinda, S.; Vootiprux, V.
Journal of the Medical Association of Thailand 64(4): 180-191
1981
ISSN/ISBN: 0125-2208 PMID: 6942080 Document Number: 172846
A clinical trial of combined intensive chemotherapy, radiotherapy and immunotherapy for acute lymphoblastic leukemia was carried out in 51 children aged 4 mo. to 12 yr. The induction of remission consisted of prednisolone (PRED) plus either vincristine (VCR), methotrexate (MTX) or 6-mercaptopurine (6-MP). After complete remission, they all received CNS prophylaxis with 2400 R brain radiotherapy with 60Co plus intrathecal MTX once weekly for 4 wk; then once every 3 mo. They were then maintained with either Siriraj protocol I or Siriraj protocol II for 5 yr. In Siriraj protocol I, oral daily 6-MP was given with high weekly dose of MTX and CTX plus intermittent pulse treatment with prednisolone and vincristine every 3 mo. For Siriraj protocol II, intensive regimen with the combination of PRED, 6-MP, MTX and CTX was given 1 wk every mo. Immunotherapy with BCG vaccination (10 intradermal injections of 0.1 ml BCG vaccine) was started at 1 yr after complete remission, then repeated every mo. for 4 mo. and continued every 3 mo. for 4 yr. All treatment was stopped after continuous complete remission for 5 yr. At present, 29 of 51 cases (56.8%) are still alive after 1 10/12-13 yr; 26 of them (50.9%) are still in continuous complete remission. All treatment was discontinued in 10 of 22 patients who were followed for more than 5 yr; 9 (40.9%) of them are still in continuous complete remission 5 1/2-13 yr after diagnosis.