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Original Article
A Multicenter Retrospective Analysis on the Treatment Pattern and Outcome in Relapsed/Refractory Childhood Acute Lymphoblastic Leukemia
Clin Pediatr Hematol Oncol 2017;24:101-6.
Published online October 31, 2017
© 2017 Korean Society of Pediatric Hematology-Oncology and Korean Society for Pediatric Neuro-Oncology

Keon Hee Yoo, M.D.1, Nak Gyun Chung, M.D.2, Bin Cho, M.D.2, Hyoung Jin Kang, M.D.3, Hee Young Shin, M.D.3, Ho Joon Im, M.D.4, Jong Jin Seo, M.D.4, Young Tak Lim, M.D.5, Chuhl Joo Lyu, M.D.6, Soon Ki Kim, M.D.7, In-Sang Jeon, M.D.8, Hoon Kook, M.D.9 and Hong Hoe Koo, M.D.1

1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 2 Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 3 Department of Pediatrics, Seoul National University Children’s Hospital, Cancer Research Institute, Seoul National University College of Medicine, 4Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, 5Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, 6Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, 7Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, 8Department of Pediatrics, Gachon University Gil Medical Center, College of Medicine, Gachon University, Incheon, 9Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea
Correspondence to: Hong Hoe Koo
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
Tel: +82-2-3410-3524 Fax: +82-2-3410-0043 E-mail:
Received September 5, 2017; Revised September 13, 2017; Accepted September 25, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Although the overall survival of childhood acute lymphoblastic leukemia (ALL) approaches 85-90%, the prognosis of relapsed or refractory (R/R) ALL is grave. This study aimed to identify the treatment pattern, treatment response, and overall survival of these patients.Methods: We reviewed data of 64 patients with R/R ALL whose initial diagnosis of ALL had been made between 1 and 21 years of age. Patients who received clofarabine as part of an induction regimen were excluded. Relapsed patients were limited to those who relapsed after ≥2 prior induction regimens. Treatment patterns, response rates, and overall survival were analyzed.Results: Patients’ median age was 15.0 years (range, 6.0-25.0) at the diagnosis of R/R ALL. The most frequently used agents other than steroid were vincristine (54.0%), cytarabine (44.6%), and idarubicin (36.5%), while L-asparaginase was used in only one patient. The complete remission (CR) and overall response (OR) rates were 38.1 and 42.9%, respectively. Sixteen patients (25.4%) underwent allogeneic hematopoietic stem cell transplantation (HSCT). The 5-year overall survival was 6.7%. The survival of patients with HSCT was significantly higher compared with those without HSCT (35.2% vs 0%, P=0.0097). Among 14 patients who achieved CR or CR without platelet recovery (CRp) before HSCT, the 3-year survival was 46.9%. Conclusion: The survival of Korean patients with R/R childhood ALL was dismal despite a reasonable CR rate, whereas that of those who received HSCT after CR or CRp was excellent. More treatment options are needed to improve the overall outcome of R/R childhood ALL.
Keywords: Childhood, Acute lymphoblastic leukemia, Relapsed, Refractory
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October 2018, 25 (2)
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