Overt testicular disease at diagnosis in childhood acute lymphoblastic leukemia: Prognostic significance and role of testicular irradiation.
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Date
2010-07
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Abstract
Objective. To analyze the prognostic impact of overt testicular disease (OTD) at diagnosis and role of testicular irradiation
in the same.
Methods. Data of 579 boys treated at our center over 16 years was reviewed.
Results. Fourteen (2.4%) males had OTD. 10 (71.4%) of these had high-risk disease. Patients with OTD, had a significantly
higher incidence of mediastinal-adenopathy (p=0.001), hyperleucocytosis (p=0.004) and CNS disease at presentation
(p<0.0001) compared to patients in continuous complete remission (CCR). 4 of the 11 patients with OTD, who opted for
therapy, had relapse; 2 are in CCR. Although, survival in patients with OTD was inferior (p=0.183) compared to patients without
OTD, it was not an independent prognostic factor (p=0.47). In the entire study cohort, symptom-diagnosis interval (p=0.006),
white cell (p=0.001) and platelet count (p=0.001) at presentation were significantly associated with survival (Cox multivariate
regression analysis).
Conclusions. OTD was not an independent prognostic factor, despite association with high-risk features. Survival outcome
was inferior. The observations indicate the need of revaluation of the present protocol with incorporation of intermediate dose
and subsequently high-dose methotrexate (after assessment for toxicity and tolerance), risk-stratified therapy and plausibly omission of testicular irradiation.
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Keywords
Overt testicular disease, Overall survival, Prognostic factors, Relapse
Citation
Marwaha R K, Kulkarni K P, Bansal D, Trehan A. Overt testicular disease at diagnosis in childhood acute lymphoblastic leukemia: Prognostic significance and role of testicular irradiation. Indian Journal of Pediatrics. 2010 July; 77(7): 779-783.