Usefulness of the mononucleotide marker "BAT-26" for identification of microsatellite instability in colorectal cancers.

s Kulkarni et al, 2010 45 (8.46) 24 21 22 (48.8) 18 (40.0) 5 (11.2) NA NA Case reports Bhatti et al, 2010 1 10 1 (gut) 1 yes died Kulkarni et al, 2009 1 5 1 (O) 1 yes lost Radhakrishnan et al, 2009 1 10 1 1 yes died Wadhwa et al, 2007 1 4 1(+O) 1 yes NA Naithani et al, 2006 1 1 (O) 1 yes alive! Padmanjali et al, 2004 1 6 1 (bone) 1 no lost Geetha et al, 1999 1 4 1& 1 yes died Lodha et al, 1998 1 5 1 (+T) 1 yes NA ##In all the studies and abstract initial treatment in all patients was primarily a uniform, non-risk stratified therapy regimen (like MCP841 protocol or modified UKALLX protocol). @@relapse classified as very early (within 18 months of starting therapy), early (from 18 months of start of therapy till within 6 months of completion of therapy) and late (beyond 6 months of completing therapy), #Isolated extramedullary relapse except CNS and testis^age at initial diagnosis in years, +relapse classified as early on-therapy (within 12 months of starting therapy) late on-therapy (from 12 months of starting therapy to completion of therapy) and off therapy relapse (beyond completion of therapy), **All with second relapse, )patients with isolated testicular relapse were treated with modified CCG-112 protocol, $3 patients relapsed on therapy, 6 within 6 months off therapy and 3 beyond 6 months off therapy, @unclear if any of the relapsers had combined relapse and relapse at sites other than CNS not described, ++all patients underwent hematopoietic stem cell transplant, other treatment details not described, *3 patients out of 10 (7 of which were relapsed) patients surviving; outcome of relapsed ALL unclear, (only off therapy relapses included, !!underwent HSCT, &unclear if only isolated relapse; BM: bone marrow, CNS: central nervous system, O: ocular, T: testicular, NA: not available, SIOP: International Society of Pediatric Oncology, VE: very early, E: early, L: late relapse. Numbers in parenthesis indicate percentages. Toshiaki Watanabe et al Asian Pacific Journal of Cancer Prevention, Vol 12, 2011 1102 but do not address treatment and outcome of relapsed ALL (Table 1) (Kulkarni et al., in press). Except as described by Goyal et al, limited therapy has been administered to most relapsed patients in sharp contrast to intensive therapy and bone marrow transplant employed in resource plenty nations. 2 studies on testicular relapse, 1 study on posttreatment relapse and 6 case reports have clearly depicted outcome of relapse (Shama et al, 2005). Only 1 study and a case-report have discussed use of hematopoietic stem cell transplant (HSCT) in 8 relapsed patients. The survival outcome except in a sole study is poor (Shama et al., 2005). Based on the currently available data, the percentage of patients with relapsed ALL is likely high in India. Outcome of only a small fraction of the expected number of relapsed patients (out of the estimated 10000 new childhood ALL cases diagnosed annually) is published. It is currently difficult to estimate the overall post relapse survival for the entire country. However it is likely to be poor given the significant resource limitation along with socioeconomic and infrastructural constraints in several centers (Kulkarni et al, 2011). Additionally, high percentages of early, on therapy and extramedullary relapse in several series necessitate reappraisal of treatment protocols. There is clear need of generation of accurate epidemiological data and reporting of all cases with a consolidated nationwide effort. Prospective trials with facilities for HSCT are pivotal in our endeavour to deliver adequate/appropriate therapy and care. Determination of cytogenetics, molecular and biological characteristics of relapsed disease would be helpful in identifying high-risk features relevant to local population and in advocating risk adapted therapy. With a potentially enlarging cohort of patients with relapse, focus needs to be on therapy and salvage of relapsed disease along with improvements in upfront therapy.