Häufigkeit und Behandlungsergebnisse testikulärer Rezidive bei der akuten lymphoblastischen Leukämie im Kindesalter

Abstract 405 boys with akute lymphoblastic leukemia (ALL) registered for the BFM Studies 1970/76, 1976/79 and 1979/81 achieved complete remission. 29 of them experienced a testicular relapse during the course of the disease. In 15 patients isolated relapses were diagnosed. One or both testes and other sites were involved in 14 children. No significant difference was found with respect to the age at diagnosis and initial white blood cell count (WBC) comparing these boys to the non relapsed group. Patients with isolated testicular relapses tended to have lower WBC, however. Additionally, four differently pretreated boys (three with isolated testicular relapses) were included in the analysis, who underwent the same treatment protocol when relapsed. Treatment for relapse was done with an intensive multiple agent chemotherapy according to the recommendations of the BFM study group. Additionally, local control of the disease was to be achieved by surgery and/or radiotherapy. Commonly used radiation doses were 24/30 Gy, the higher dose usually delivered to patients who did not undergo surgery. With few exceptions testicular relapses occurred after discontinuation of maintenance therapy from the beginning of the third to the end of the fourth year after diagnosis, thus showing a pattern that differs clearly from relapses at other sites. Treatment results were favourable in the patients: At the day of evaluation 16 out of 18 boys with isolated and 13 out of 15 boys with combined testicular relapses were alive with a median observation time of 20 and 9 month, respectively. ln 12 children therapy for relapse has been completed. An estimation on the basis of our data shows a long-time survival without any further relapse for about 70% of our patients. Until now there is no significant difference between combined and isolated testicular relapses according to the prognosis. These findings indicate that testicular relapses are a result of persistent local disease. Concomitant systemic involvement probably has to be regarded as a spread from the leukemic testicle and to be treated accordingly. It is suggested that the difference between isolated and combined testicular relapses is only an arbitrary one due to insufficient diagnostic means.