A retrospective Study of Testicular Relapse in Acute Lymphoblastic Leukemia


ABSTRACT:BACKGROUND:Testicular relapse in ALL usually appear as painless testicular enlargement mostly unilateral. Diagnosed by wedge biopsy. The testis is a frequent site of relapse.OBJECTIVE:To find out the incidence of testicular relapse in ALL, time of diagnosis of testicular relapse, age group more commonly associated with testicular relapse, the association of testicular relapse with other relapses (medullary or extra-medullary), and prognosis of patients with testicular relapse.PATIENTS AND METHODS:Aretrospective study in the central teaching hospital of children in Baghdad- unit of hematology and oncology, during January 2000 – December 2006.Two hundred-four males were studied retrospectively. Informations were obtained from patients' files.RESULTS:The incidence of testicular relapse was in 18 patients represented (8.8%) of total cases of boys with ALL below 15 years. Relapse is mainly unilateral in 15 patients (83.3%) and mostly in the right side in 11 patients (61.1%) of total cases with testicular relapse.There is no significant statistical incidence of relapse with the age of patient represented by 2 cases (6.2%) from (0-2 years), 11 cases (8.2%) from (2-10 years), and 5 cases (13%) more than (10 years). Time of diagnosis of relapse was mainly during the oral maintenance therapy (13) patients (72.5%). Testicular relapse was isolated in 8 patients (44%) and combined with other relapses in 10 patients (56%) of them 7 patients (39%) with bone marrow relapse and 3 patients (17%) with CNS relapse.The outcome of patients with testicular relapse was better after discontinuation of chemotherapy “after three years of treatment” (2 cases diagnosed with relapse both of them still alive) represented (100%), while during the maintenance therapy of 13 patients, 6 (46.2%) of them still alive, 6 patients (46.2%) of them died, and 1 patient (7.6%) with no report, while induction chemotherapy 2 cases 1 (50%) alive and 1 (50%) died). Patients with isolated testicular relapse had better outcome represented by 6 patients (75%) still alive and 2 patients (25%) died, patients with combined relapse had worse outcome, represented by 3 patients (30%) alive, 5 patients (50%) died, and 2 patients (20%) with no report.Incidence of testicular relapse significantly decreased after the introduction of more intensive chemotherapy in Jan 2004 from 9.8% to 3.1%.CONCLUSION:Incidence of testicular relapse decrease with introduction of intensive chemotherapy and had higher incidence during the maintenance therapy, associated with increased incidence with other medullary and extra-medullary relapses, and has better prognosis when it is late and isolated than for early and combined relapse