Clinical, haematological, and radiological features in T-cell lymphoblastic malignancy in childhood

T-cell lymphoblastic malignancy in childhood includes both T-cell acute lymphoblastic leukaemia (T-ALL) and non-Hodgkin's lymphoblastic lymphoma (T-NHL). There is considerable overlap between these disorders, which probably represent two ends of the same disease spectrum. To determine whether there are radiological differences between T-ALL and T-NHL we reviewed the clinical, haematological and radiological features of 58 children seen in one centre over a 9-year period. Splenomegaly and adenopathy were significantly more common in T-ALL than in T-NHL. Patients with T-ALL were usually anaemic and thrombocytopenic, with elevated white blood cell counts; patients with T-NHL had normal blood counts. The radiological abnormalities seen were mediastinal enlargement, pleural effusions, and tracheal compression. All patients with T-NHL had abnormal chest radiographs, whereas 10 of 39 patients with T-ALL had normal chest radiographs. When only abnormal radiographs were compared, however, there were no differences in the degree of mediastinal widening or in the size of pleural effusions. Tracheal compression was more common in T-NHL and was always most marked in the intrathoracic airway and in an anteroposterior direction. We conclude that there is little difference in the radiological abnormalities seen in T-ALL and T-NHL, which further supports the theory that they represent points along a common spectrum of disease. As airway compression is primarily intrathoracic and in an antero-posterior direction, adequate radiological evaluation should include a lateral chest radiograph

A second course of treatment for childhood acute lymphoblastic leukaemia: long-term follow-up is needed to assess results.

We report the results of long-term follow-up of 94 children who completed treatment for acute lymphoblastic leukaemia (ALL) between 1974 and 1986 and subsequently experienced a bone marrow relapse before 1992. 91 children received further induction, intensification and CNS directed therapy; 19 proceeded to BMT or ABMT and the remainder were treated on one of three protocols which increased in intensity. The duration of second remission improved significantly with increasing intensity of treatment and bone marrow transplantation was followed by fewer relapses than chemotherapy. Analysis of factors influencing the duration of second remission showed that only length of first remission was of additional significance; the median duration of second remission being only 19 months in children with a first remission of less than 4 years and 62 months in those with longer first remissions. 29 children electively stopped chemotherapy a second time but only 11 of these remain still in second remission with recurrences occurring for up to 7 years from the the time first relapse. Only three of the 24 long-term survivors had no significant late effects of treatment; these were most marked in children who had received a second course of radiotherapy. We conclude that very long follow-up is necessary to determine whether patients may be successfully re-treated following late bone marrow relapse and that all such treatment is associated with a high incidence of late effects

Clinical features, cytogenetics and outcome in acute lymphoblastic and myeloid leukaemia of infancy: report from the MRC Childhood Leukaemia working party

The clinical features, cytogenetics and response to treatment have been examined in 180 infants (aged <1 year) with acute leukaemia; 118 with acute lymphoblastic leukaemia (ALL) and 62 with acute myeloid leukaemia (AML). Comparison of clinical features showed no difference in age or sex distribution between infants with ALL and AML but infants with ALL tended to have higher leucocyte counts at presentation. Cytogenetic abnormalities involving 11q23 were found in 66% of ALL and 35% of AML cases, the commonest, t(4;11) being found only in ALL. The other recognised 11q23 translocations were found in both types of leukaemia. Few patients had the common cytogenetic abnormalities associated with ALL in older children and few with AML had good risk abnormalities. Four year event-free survival 60% cf 30% (P = 0.001) and survival 65% cf 41% (P = 0.007) were significantly better in AML than ALL. These results were due to a lower risk of relapse 27% cf 62% at four years. Superior event-free survival was also seen in the subgroup of patients with 11q23 abnormalities and AML (55% cf 23%). The reasons for superior response in AML are unknown but may be related to the intensity of treatment, lineage of the leukaemia or other as yet unidentified factors