BACKGROUND: The isolated recurrence of testicular leukemia in boys with acute lymphoblastic leukemia (ALL) is considered to be an ominous sign, heralding generalized recurrence. In general, treatment is comprised of systemic retreatment and local radiotherapy to one or both affected tests. METHODS: In this study, the authors report five boys with a late isolated testicular recurrence of ALL during sustained bone marrow remission, in whom radiotherapy had been omitted. High dose methotrexate was included in the treatment regimen. RESULTS: No further recurrences occurred after cessation of therapy. The follow-up period ranged from 1-15 years (median, 8 years). CONCLUSIONS: These cases show that there is a subpopulation of boys with recurrence of testicular leukemia who can be treated without radiotherapy. Therefore, the authors propose a treatment regimen for boys with late isolated recurrence of testicular leukemia in which conventional reinduction maintenance treatment is given in combination with high dose methotrexate. Radiotherapy should be withheld until subsequent testicular recurrence occurs.
BACKGROUND: The isolated recurrence of testicular leukemia in boys with acute lymphoblastic leukemia (ALL) is considered to be an ominous sign, heralding generalized recurrence. In general, treatment is comprised of systemic retreatment and local radiotherapy to one or both affected tests. METHODS: In this study, the authors report five boys with a late isolated testicular recurrence of ALL during sustained bone marrow remission, in whom radiotherapy had been omitted. High dose methotrexate was included in the treatment regimen. RESULTS: No further recurrences occurred after cessation of therapy. The follow-up period ranged from 1-15 years (median, 8 years). CONCLUSIONS: These cases show that there is a subpopulation of boys with recurrence of testicular leukemia who can be treated without radiotherapy. Therefore, the authors propose a treatment regimen for boys with late isolated recurrence of testicular leukemia in which conventional reinduction maintenance treatment is given in combination with high dose methotrexate. Radiotherapy should be withheld until subsequent testicular recurrence occurs.
Authors: Julio C Barredo; Caroline Hastings; Xiamin Lu; Meenakshi Devidas; Yichen Chen; Daniel Armstrong; Naomi Winick; Brent Lee Wood; Rochelle Yanofsky; Mignon Loh; Julie M Gastier-Foster; Dean Thomas Jorstad; Robert Marcus; Kim Ritchey; William L Carrol; Stephen P Hunger Journal: Pediatr Blood Cancer Date: 2017-12-29 Impact factor: 3.167