Pediatric Acute Lymphoblastic Leukemia (ALL) Standard Treatment Protocols – COG Protocol

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Pediatric ALL COG protocol - bone aspirates

Pediatric ALL COG protocol uses three drug induction and risk based therapy.Image courtesy: http://www.genomenewsnetwork.org/

Continuing to delve into treatment options for acute lymphoblastic leukemia (ALL) in children, I will be talking about some standard protocols that are followed for treatment based on risk category of condition.

Children’s Oncology Group (COG) Protocol

Chemotherapy is the default treatment option on an ALL diagnosis. In standard course of treatment, ALL chemotherapy regimen would involve

Corticosteroid, this may be dexamethasone or prednisone
Vincristine
L-asparaginase
Doxorubicin/Daunorubicin

Certain ALL study groups have a less intensive induction regimen based on many factors. The Children’s Oncology Group (COG) protocols use a three-drug induction regimen, involving, corticosteroid, vincristine, and L-asparaginase. The protocol does not administer anthracycline during induction therapy in patients classified as standard risk-precursor B-cell ALL according to the National Cancer Institute (NCI). The three-drug regimen of COG protocol has been proved to enjoy a 95% complete remission rate for standard risk patients.

COG uses factors to determine immunophenotype and National Cancer Institute risk group classification prior to deciding on the intensity of induction therapy. According to the NCI, risk group classification,

- Standard risk – WBC count less than 50,000/mL and age group of 1-10years

- High risk – WBC count 50000/mL or greater and age 10 years and above.

Children undergoing COG protocols are initially classified into treatment groups based on prognostic factors like,

- Age

- Immunophenotype

- WBC count at diagnosis

- Presence of extramedullary disease

Survival rates in children in the age group of 1 to 10 years are almost 85% in standard risk group while the survival rates are 70% in children in high-risk category. There are cases where in even this risk-adapted multiagent chemotherapy regimens fail or show poor prognosis, such cases require different therapeutic approaches. Infants diagnosed with ALL are at a higher risk of treatment failure when compared to older children. Infants with ALL diagnosis are treated using a more intensified protocol.

The COG protocol of risk group based treatment is prognostically more significant after relapse. Patients who meet the NCI standard risk criteria fared better after relapse when compared to the high-risk group patients.

One of the COG risk group classifications, currently under evaluation is,

COGAALL08B1 – COG protocol AALL08B1 segregates patients with ALL B-precursor patients into low risk, average risk, high risk, and very-high risk based on,

Age and leukocyte count
Initial CNS status
Genetic abnormalities
Day 8 peripheral blood MRD
Day 29 bone marrow morphologic response and MRD

About COG

The Children’s Oncology Group is a National Cancer Institute supported clinical trials group. This is the world’s largest organization devoted exclusively to pediatric cancer research. The COG conducts clinical research and translational research trials for infants, children, adolescents, and young adults with cancer. Almost all centers that treat children with cancer in the US and Canada are part of the COG, which encompasses more than 200 centers in the United States, Canada, Switzerland, the Netherlands, Australia, and New Zealand. COG member institutions have multidisciplinary teams consisting of physicians, research scientists, nurses, psychologists, pharmacists, and other specialists who use their specialty skills in the diagnosis, management, and investigation of childhood cancer. (From Wikipedia)

Listed below are clinical trials investigating various ALL treatment protocols.