Survival and endocrine outome after testicular relapse in acute lymphoblastic leukaemia
a Department of Haematology and Oncology, Institute of
Child Health, London, b Department of Endocrinology, Institute of Child Health, London, c Department of Haematology and Oncology,
Great Ormond Street Hospital for Children NHS Trust, London
Correspondence to: Dr R G Grundy, Haematology and Oncology, Institute of Child Health, Guilford Street, London WC1N 1EH.
Accepted 4 November 1996
Survival and endocrine status in a cohort of boys with acute
lymphoblastic leukaemia (ALL) who started treatment between 1972 and
1987 and subsequently developed a testicular relapse were analysed.
During this period there was a significant improvement in the overall
event free survival for boys, but no significant decrease in the
testicular relapse rate. Thirty three boys had an apparently isolated
testicular relapse, whereas 21 boys had a combined relapse. The event
free survival for boys with an isolated testicular relapse was 59% at
six years (95% confidence interval (CI) 42 to 74%). The event free
survival for the 16 patients with a combined relapse who received a
second course of treatment was 32% (95% CI 17 to 60%). Those
patients receiving adequate second line treatment for an isolated
testicular relapse whose first remission was longer than or equal to
two years had an event free survival of 82% (95% CI 63 to 93%) at
six years. No boy relapsing within two years from diagnosis has
survived. Endocrine late effects are significant, with 82% of the boys
requiring hormonal treatment at some stage for induction of puberty or
continuing pubertal maturation, or both. It is concluded that, despite
the increasing intensity of initial treatment for ALL, isolated
testicular relapse is treatable by conventional means in most patients.
Careful endocrine follow up of these patients is essential as most will
require hormone replacement treatment.
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© 1997 by Archives of Disease in Childhood
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