PURPOSE: To improve efficacy and reduce toxicity of treatment for children with acute lymphoblastic leukemia. PATIENTS AND METHODS: Patients from all risk groups, including infants and those with T-cell disease, were treated between 1987 and 1991. Standard-risk (SR) patients did not receive cranial irradiation, whereas high-risk (HR) and very high-risk (VHR) patients participated in a randomized comparison of 18 Gy of cranial irradiation conventionally fractionated versus two fractions per day (hyperfractionated). RESULTS: At a median follow-up of 9.2 years, the 9-year event-free survival (EFS +/- SE) was 75% +/- 2% for all 369 patients, 77% +/- 4% for the 142 SR patients, and 73% +/- 3% for the 227 HR/VHR patients (P =.37 comparing SR and HR/VHR). The CNS, with or without concomitant bone marrow involvement, was the first site of relapse in 19 (13%) of the 142 SR patients: 16 (20%) of 79 SR boys and three (5%) of 63 SR girls. This high incidence of relapses necessitated a recall of SR boys for additional therapy. CNS relapse occurred in only two (1%) of 227 HR and VHR patients. There were no outcome differences found among randomized treatment groups. Nine-year overall survival was 84% +/- 2% for the entire population, 93% +/- 2% for SR children, and 79% +/- 3% for HR and VHR children (P <.01 comparing SR and HR/VHR). CONCLUSION: A high overall survival outcome was obtained for SR patients despite the high risk of CNS relapse for SR boys, which was presumed to be associated with eliminating cranial radiation without intensifying systemic or intrathecal chemotherapy. For HR/VHR patients, inability to salvage after relapse (nearly all of which were in the bone marrow) remains a significant clinical problem.
RCT Entities:
PURPOSE: To improve efficacy and reduce toxicity of treatment for children with acute lymphoblastic leukemia. PATIENTS AND METHODS: Patients from all risk groups, including infants and those with T-cell disease, were treated between 1987 and 1991. Standard-risk (SR) patients did not receive cranial irradiation, whereas high-risk (HR) and very high-risk (VHR) patients participated in a randomized comparison of 18 Gy of cranial irradiation conventionally fractionated versus two fractions per day (hyperfractionated). RESULTS: At a median follow-up of 9.2 years, the 9-year event-free survival (EFS +/- SE) was 75% +/- 2% for all 369 patients, 77% +/- 4% for the 142 SRpatients, and 73% +/- 3% for the 227 HR/VHR patients (P =.37 comparing SR and HR/VHR). The CNS, with or without concomitant bone marrow involvement, was the first site of relapse in 19 (13%) of the 142 SRpatients: 16 (20%) of 79 SRboys and three (5%) of 63 SRgirls. This high incidence of relapses necessitated a recall of SRboys for additional therapy. CNS relapse occurred in only two (1%) of 227 HR and VHR patients. There were no outcome differences found among randomized treatment groups. Nine-year overall survival was 84% +/- 2% for the entire population, 93% +/- 2% for SRchildren, and 79% +/- 3% for HR and VHR children (P <.01 comparing SR and HR/VHR). CONCLUSION: A high overall survival outcome was obtained for SRpatients despite the high risk of CNS relapse for SRboys, which was presumed to be associated with eliminating cranial radiation without intensifying systemic or intrathecal chemotherapy. For HR/VHR patients, inability to salvage after relapse (nearly all of which were in the bone marrow) remains a significant clinical problem.
Authors: Lynda M Vrooman; Donna S Neuberg; Kristen E Stevenson; Barbara L Asselin; Uma H Athale; Luis Clavell; Peter D Cole; Kara M Kelly; Eric C Larsen; Caroline Laverdière; Bruno Michon; Marshall Schorin; Cindy L Schwartz; Harvey J Cohen; Steven E Lipshultz; Lewis B Silverman; Stephen E Sallan Journal: Eur J Cancer Date: 2011-04-20 Impact factor: 9.162
Authors: Yousif Matloub; Susan Lindemulder; Paul S Gaynon; Harland Sather; Mei La; Emmett Broxson; Rochelle Yanofsky; Raymond Hutchinson; Nyla A Heerema; James Nachman; Marilyn Blake; Linda M Wells; April D Sorrell; Margaret Masterson; John F Kelleher; Linda C Stork Journal: Blood Date: 2006-04-11 Impact factor: 22.113
Authors: Albert Moghrabi; Donna E Levy; Barbara Asselin; Ronald Barr; Luis Clavell; Craig Hurwitz; Yvan Samson; Marshall Schorin; Virginia K Dalton; Steven E Lipshultz; Donna S Neuberg; Richard D Gelber; Harvey J Cohen; Stephen E Sallan; Lewis B Silverman Journal: Blood Date: 2006-09-26 Impact factor: 22.113
Authors: Barbara L Asselin; Meenakshi Devidas; Chenguang Wang; Jeanette Pullen; Michael J Borowitz; Robert Hutchison; Steven E Lipshultz; Bruce M Camitta Journal: Blood Date: 2011-04-07 Impact factor: 22.113
Authors: Susan L Kearney; Suzanne E Dahlberg; Donna E Levy; Stephan D Voss; Stephen E Sallan; Lewis B Silverman Journal: Pediatr Blood Cancer Date: 2009-08 Impact factor: 3.167
Authors: Lynda M Vrooman; Jeffrey G Supko; Donna S Neuberg; Barbara L Asselin; Uma H Athale; Luis Clavell; Kara M Kelly; Caroline Laverdière; Bruno Michon; Marshall Schorin; Harvey J Cohen; Stephen E Sallan; Lewis B Silverman Journal: Pediatr Blood Cancer Date: 2010-02 Impact factor: 3.167
Authors: L B Silverman; K E Stevenson; J E O'Brien; B L Asselin; R D Barr; L Clavell; P D Cole; K M Kelly; C Laverdiere; B Michon; M A Schorin; C L Schwartz; E W O'Holleran; D S Neuberg; H J Cohen; S E Sallan Journal: Leukemia Date: 2009-12-17 Impact factor: 11.528