Study of reinduction chemotherapy in bone marrow relapse of childhood acute lymphoblastic leukemia

: Twenty children with acute lymphoblastic leukemia (ALL) in relapse were treated with various combinations of anti-leukemic agents in approach to the induction of remission. Among them, the four-drug reinduction regimen consisting of prednisolone, vincristine, daunomycin and L-asparaginase (PVDA regimen) was found to be highly effective. The incidence of remission was 100% (2/2) for first reinduction. The regimen also proved to be effective in the management of multiple subsequent relapses. The rate of remission induction for second and third to fifth reinduction attempts were 60% (3/5) and 50% (4/8), respectively. The over all remission rate was 60%. The median duration of subsequent remission for the entire patients treated by PVDA regimen was short, only 11 weeks (range: 3 to 26 weeks). PVDA regimen was effective in reinduction of remission in childhood ALL with relapse, but was not effective in remission maintenance. Optimal maintenance therapy for subsequent remissions has to be determined.