Treatment Failure

Treatment failure has not been defined specifically for ALL' and therefore the revised criteria set forth recently for AML should be used/ with some modifications. Treatment failure includes all patients who did not achieve a CR' or in phase I or II trials' a PR' and should be subclassified into several categories. "Treatment failure due to refractory disease" should be defined differently than it is in AML1 because the induction treatment in ALL spreads over at least 3 weeks. One could define treatment failure as patients who have persistent peripheral blood blasts 7 days from initiation of induction treatment'45'46 or persistent bone marrow blasts (>5%) 14 days from initiation of induction treatment.4546 Table 14.3 demonstrates the number of patients analyzed for each recommendation. "Treatment failure due to complications from aplasia" was described in AML1 but' to the best of our knowledge' was not described in ALL. "Finally' treatment failure of indeterminate cause" should be defined for ALL. It can include two categories as described for AML1 with modifications due to different treatment regimens. One category should include those patients who die less than 7 days after initiation of treatment and the other category should include those patients who survive seven or more days after the initiation of treat-

Table 14.3 Number of patients analyzed for persistence of peripheral blood and bone marrow blasts during remission induction
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