Testicular Relapse of ALL

Selina M. Luger, MD
Last Modified: January 13, 2002

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Question

Dear OncoLink "Ask The Experts,"

Are you aware of any patients or statistics regarding ALL (Acute Lymphocytic Leukemia) with testicular relapse? We believe our son is in this position and we have yet to find a similar case.  


Answer

Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania, responds:

We usually think of leukemia as a disease of the bone marrow. Sometimes leukemia is found in other locations throughout the body. For most of these locations, chemotherapy that we give is effective in getting there and treating the leukemia as well. However there are places where there appear to be barriers between the regular blood supply and the location/organ's supply. These are called "sanctuary sites" because the leukemia uses those areas to hide. These barriers prevent the chemotherapy from penetrating well. So if leukemia gets in there, regular chemotherapy is not as successful at treating the leukemia. If leukemia cells are in a sanctuary site, we must treat those areas independently.

The testicles are considered a sanctuary site for ALL, as is the central nervous system. Because chemotherapy does not penetrate the testicles well, other treatments such as radiation therapy are considered. Because patients who develop a relapse in sanctuary sites are at higher risk for recurrence of disease elsewhere, chemotherapy may be considered for treatment of these other areas. In a complicated situation such as this, a pediatric specialist at a cancer center should be consulted.



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Pediatric Regimen Beats Adult Chemo for Young Adults With ALL

Apr 24, 2012 - Adolescent and young adult patients with acute lymphoblastic leukemia who are treated with pediatric-inspired regimens exhibit lower all-cause mortality, higher complete remission and event-free survival rates, and lower relapse rates compared with those treated with conventional adult-chemotherapy regimens, according to a study published in the May issue of the American Journal of Hematology.



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