الفهرس 
PathobiologyOnly 14 pages are availabe for public view
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Abstract
Acute leukemia is the most common cancer in children, with acute lymphoblast1c leukemia (ALL) the
most common subtype. Despite improvements in the treatment of pediatric acute lymphoblastic
leukemia, approximately one in five patients will develop recurrent djsease. The ultimate objective
of the study were to re induce and mruntain disease remission for children with relapsed ALL usmg
the subjected protocol of salvage therapy and to evaluate its impact on prolonging EFS and RFS.
Also the study was designed to identify patients in relapse or those who are resistant to therapy,
analysis of underlying risk criteria and determinillg the response rate and toxicity to multi-agent
combinatton therapy used in different phases of therapy. This study was carried out on 5 I
pedjatric patients with definitive ruagnosjs of refractory or relapsing acute lymphoblastic
leukemia in first relapse
Of the fifty-one patients who were included in the study, two were refractory (4%) and 49 (96%)
with acute lymphoblastic leukemia in first relapse. Isolated medullary relapse was present in 39/49
patients (79 6°/o), isolated extramedullary relapse in S/49 patients (10 2%) [Four with isolated
CNS 8.2% and one with isolated testicular 2%] and 5/49 patients (10.2%) with combined relapse [two
combined hematological and CNS (4.1%) and three combined hematological and testicular (6.1%)).
By the end of 31 November 2000, 26 patients (51%) were alive in second complete remission, 22
patients {43.1%) off therapy (three resistant and 19 relapsing) and three patients (5.9%) rued (Two
during re-induction and one during intensive module one cycle I). The estimated two- year EFS was
38.5%, while the estimated two year RFS was 42.I%. EFS and RFS in relation to age, sex,
hepatomegaly, FAB and IPT showed no statistical significant differences On the other hand the two
year
probability of RFS was 77% for TLC <10 xl09 II versus 28% for 1LC > 10 x109 II
Results are statistically significant (p = 0.039). Al.so RFS in relation to spleoomegaly, duration
of 111 CCR and initial line of therapy shows sjgnificant statistical difference (P.value <0.05).
Toxicities to rufferent phases of treatment were recorded; with a hlgher incidence of sever
myelosuppresion (neutropenia grade 4) following consolidation I (FLAG) however mortality related
septic episodes were not documented in relation to this phase of treatment (FLAG). The subjected
protocol of salvage therapy was tolerable and successful in achleving two year RFS of 42% compared
to 5 % in previous protocols used m our institute.