Treatment of occult or late overt testicular relapse in children with acute lymphoblastic leukemia: A pediatric oncology group study

Marcia M. Wofford, Stephen D. Smith, Jonathan J. Shuster, Warren Johnson, George R. Buchanan, Moody D. Wharam, A. Kim Ritchey, David Rosen, Mary E. Haggard, Barry L. Golembe, Gaston K. Rivera

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Purpose: The Pediatric Oncology Group (POG) designed a randomized two-arm protocol (8304) to improve the survival of children with acute lymphoblastic leukemia (ALL) who experience an isolated testicular relapse and to evaluate the efficacy of teniposide (VM-26) and doxorubicin as intensification agents during second remission. The outcome and toxicity observed in 80 patients with isolated testicular leukemia treated on POG 8304 are presented. Patients and Methods: The following are common features of POG 8304: (1) remission reinduction therapy with vincristine, prednisone, and doxorubicin; (2) bilateral testicular irradiation (2,600 cGy) during reinduction therapy; (3) CNS prophylaxis with intrathecal hydrocortisone, methotrexate (MTX), and cytarabine (Ara-C); and (4) continuation therapy (for 80 weeks) with alternating 6-week cycles of oral mercaptopurine (6-MP)/MTX and intravenous vincristine and cyclophosphamide. Treatment differences consisted of pulses (administered every 7 weeks) of either prednisone and doxorubicin (arm 1) or VM-26 and Ara-C (arm 2) during continuation therapy and a 4-week late intensification phase with either vincristine, prednisone, and doxorubicin (arm 1) or VM-26 and Ara-C (arm 2). Results: Fifty-five boys with ALL had isolated micro-scopic testicular leukemia detected by an elective biopsy at completion of initial treatment, and 25 had a late (≥ 6 months off-therapy) isolated overt testicular relapse. All patients with overt testicular leukemia attained a second clinical remission, and no patient with microscopic testicular leukemia progressed during reinduction. Of 42 patients on arm 1,11 have relapsed compared with 18 of 38 patients on arm 2 (log-rank analysis, P = .22), indicating no significant difference between an anthracycline and an epipodophyllotoxin-Ara-C combination in the treatment of testicular leukemia. The overall 4-year event-free survival (EFS) among boys with occult testicular relapse was 53% ± 8%. Age greater than 10 years at initial diagnosis, a WBC count greater than 50,000/μL at diagnosis, and black race were associated with a worse outcome. The 4-year EFS for boys with a late overt testicular relapse was 84% ± 10%, and these patients fared significantly better than patients with occult disease (P = .007). Conclusion: The treatment approach reported here can secure a prolonged second remission in many patients with occult or late overt testicular leukemia.

Original languageEnglish (US)
Pages (from-to)624-630
Number of pages7
JournalJournal of Clinical Oncology
Issue number4
StatePublished - 1992

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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