PURPOSE: Approximately 20% of children with acute lymphoblastic leukemia (ALL) suffer a relapse, and their prognosis is unfavorable. Between 1987 and 1990, the multicenter trial Acute Lymphoblastic Leukemia-Relapse Study of theBerlin-Frankfurt-Münster Group (ALL-REZ BFM) 87 was conducted to establish a uniform treatment for these children in Germany and Austria. PATIENTS AND METHODS: Of 207 registered patients, 183 patients were stratified into three groups according to the protocol: A, early bone marrow (BM) relapse (n = 56); B, late BM relapse (n = 101); C, isolated extramedullary relapse (n = 26). Treatment consisted of risk-adapted alternating short-course multiagent systemic and intrathecal chemotherapy, cranial irradiation, if indicated, and conventional maintenance therapy. Additionally, 24 patients with an exceptionally poor prognosis (early BM or any relapse of T-cell ALL) were treated with individual regimens. In 35 patients, stem-cell transplantation was performed. RESULTS: The probability of event-free survival (EFS) and overall survival of all registered patients at 15 years was 0.30 +/- 0.03 and 0.37 +/- 0.03, respectively, with significant differences between the strategic groups (A, 0.18 +/- 0.05 and 0.20 +/- 0.05; B, 0.44 +/- 0.05 and 0.52 +/- 0.05; C, 0.35 +/- 0.09 and 0.42 +/- 0.10). Despite risk-adapted treatment, an early time point of relapse and T-lineage immunophenotype were significant predictors of inferior EFS in uni- and multivariate analyses. CONCLUSION: With the ALL-REZ BFM 87 protocol, more than one-third of patients may be regarded as cured from recurrent ALL with second complete remissions lasting more than 10 years. Immunophenotype and time point of relapse are important prognostic factors that allow us to adapt more precisely treatment intensity to individual prognosis in future trials.
RCT Entities:
PURPOSE: Approximately 20% of children with acute lymphoblastic leukemia (ALL) suffer a relapse, and their prognosis is unfavorable. Between 1987 and 1990, the multicenter trial Acute Lymphoblastic Leukemia-Relapse Study of the Berlin-Frankfurt-Münster Group (ALL-REZ BFM) 87 was conducted to establish a uniform treatment for these children in Germany and Austria. PATIENTS AND METHODS: Of 207 registered patients, 183 patients were stratified into three groups according to the protocol: A, early bone marrow (BM) relapse (n = 56); B, late BM relapse (n = 101); C, isolated extramedullary relapse (n = 26). Treatment consisted of risk-adapted alternating short-course multiagent systemic and intrathecal chemotherapy, cranial irradiation, if indicated, and conventional maintenance therapy. Additionally, 24 patients with an exceptionally poor prognosis (early BM or any relapse of T-cell ALL) were treated with individual regimens. In 35 patients, stem-cell transplantation was performed. RESULTS: The probability of event-free survival (EFS) and overall survival of all registered patients at 15 years was 0.30 +/- 0.03 and 0.37 +/- 0.03, respectively, with significant differences between the strategic groups (A, 0.18 +/- 0.05 and 0.20 +/- 0.05; B, 0.44 +/- 0.05 and 0.52 +/- 0.05; C, 0.35 +/- 0.09 and 0.42 +/- 0.10). Despite risk-adapted treatment, an early time point of relapse and T-lineage immunophenotype were significant predictors of inferior EFS in uni- and multivariate analyses. CONCLUSION: With the ALL-REZ BFM 87 protocol, more than one-third of patients may be regarded as cured from recurrent ALL with second complete remissions lasting more than 10 years. Immunophenotype and time point of relapse are important prognostic factors that allow us to adapt more precisely treatment intensity to individual prognosis in future trials.
Authors: Alejandro Gutierrez; Suzanne E Dahlberg; Donna S Neuberg; Jianhua Zhang; Ruta Grebliunaite; Takaomi Sanda; Alexei Protopopov; Valeria Tosello; Jeffery Kutok; Richard S Larson; Michael J Borowitz; Mignon L Loh; Adolfo A Ferrando; Stuart S Winter; Charles G Mullighan; Lewis B Silverman; Lynda Chin; Stephen P Hunger; Stephen E Sallan; A Thomas Look Journal: J Clin Oncol Date: 2010-07-19 Impact factor: 44.544
Authors: Weili Sun; Etan Orgel; Jemily Malvar; Richard Sposto; Jennifer J Wilkes; Rebecca Gardner; Vanessa P Tolbert; Alison Smith; Minjun Hur; Jill Hoffman; Susan R Rheingold; Michael J Burke; Alan S Wayne Journal: Pediatr Blood Cancer Date: 2016-07-20 Impact factor: 3.167
Authors: Jan Styczynski; Mariusz Wysocki; Robert Debski; Krzysztof Czyzewski; Beata Kolodziej; Beata Rafinska; Malgorzata Kubicka; Sylwia Koltan; Andrzej Koltan; Monika Pogorzala; Andrzej Kurylak; Dorota Olszewska-Slonina; Walentyna Balwierz; Edyta Juraszewska; Maria Wieczorek; Igor Olejnik; Maryna Krawczuk-Rybak; Marta Kuzmicz; Jerzy Kowalczyk; Jolanta Stefaniak; Wanda Badowska; Danuta Sonta-Jakimczyk; Tomasz Szczepanski; Michal Matysiak; Iwona Malinowska; Elzbieta Stanczak; Jacek Wachowiak; Benigna Konatkowska; Lidia Gil; Anna Balcerska; Lucyna Maciejka-Kapuscinska Journal: J Cancer Res Clin Oncol Date: 2007-08-02 Impact factor: 4.553
Authors: Sunil S Raikar; Lauren C Fleischer; Robert Moot; Andrew Fedanov; Na Yoon Paik; Kristopher A Knight; Christopher B Doering; H Trent Spencer Journal: Oncoimmunology Date: 2017-12-26 Impact factor: 8.110
Authors: Stephen P Hunger; Mignon L Loh; James A Whitlock; Naomi J Winick; William L Carroll; Meenakshi Devidas; Elizabeth A Raetz Journal: Pediatr Blood Cancer Date: 2012-12-19 Impact factor: 3.167
Authors: Elizabeth A Raetz; Mitchell S Cairo; Michael J Borowitz; Susan M Blaney; Mark D Krailo; Tarek A Leil; Joel M Reid; David M Goldenberg; William A Wegener; William L Carroll; Peter C Adamson Journal: J Clin Oncol Date: 2008-08-01 Impact factor: 44.544