Yousif Matloub1, Linda Stork2, Barbara Asselin3, Stephen P Hunger4, Michael Borowitz5, Tamekia Jones6, Bruce Bostrom7, Julie M Gastier-Foster8,9,10, Nyla A Heerema9, Andrew Carroll11, Naomi Winick12, William L Carroll13, Bruce Camitta14, Meenakshi Devidas15, Paul S Gaynon16. 1. Rainbow Babies & Children's Hospital, Division of Hematology-Oncology, Case Western Reserve University, Cleveland, Ohio. 2. Doernbecher Children's Hospital, Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon. 3. Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York. 4. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 5. Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland. 6. Children's Foundation Research Institute, University of Tennessee Health Science Center, Memphis, Tennessee. 7. Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota. 8. Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio. 9. Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio. 10. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio. 11. Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama. 12. Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas. 13. New York University Cancer Institute, New York, New York. 14. Midwest Center for Cancer and Blood Disorders, Pediatric Hematology-Oncology, Milwaukee, Wisconsin. 15. Department of Biostatistics, Colleges of Medicine, Public Health & Health Professions, Children's University of Florida, Gainsville, Florida. 16. Division of Hematology-Oncology, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California.
Abstract
BACKGROUND: Children with T-lineage acute lymphoblastic leukemia ALL (T-ALL) historically have had inferior outcomes compared with the children with precursor-B ALL (B-ALL). After 1995, the Children's Cancer Group (CCG) treated patients with B- and T-ALL according to the National Cancer Institute (NCI) risk criteria, basing risk stratification on age and white blood cell (WBC) count regardless of immunophenotype. The Pediatric Oncology Group (POG) treated all the patients with T-ALL on separate, generally more intensive protocols than those used to treat the patients with B-ALL. PROCEDURE: We compared the outcomes of children with T-ALL and NCI standard-risk (SR) criteria treated on CCG and POG trials between 1996 and 2005. CCG SR-ALL 1952 and 1991 enrolled 80 and 86 patients with T-ALL, respectively, utilizing a reduced intensity Berlin-Frankfurt-Münster backbone. Treatment was intensified for slow early responders and only patients with overt central nervous system leukemia received cranial irradiation. Eighty-four patients with T-ALL and SR features were enrolled on POG 9404 comprising more intensive therapy with all patients receiving cranial irradiation. RESULTS: The 7-year event-free survival (EFS) for patients with SR T-ALL on CCG 1952, CCG 1991, and POG 9404 were 74.1 ± 5.8%, 81.8 ± 5.3%, and 84.2 ± 4.3%, respectively (P = 0.18). Overall 7-year survivals were 86.1 ± 4.6%, 88.3 ± 4.4%, 89.1 ± 3.6%, respectively (P = 0.84). CONCLUSIONS: Comparable high rates of EFS and long-term survival were achieved with all three regimens, with the CCG regimens utilizing a less intensive chemotherapy backbone without prophylactic cranial irradiation for patients with SR T-ALL.
BACKGROUND:Children with T-lineage acute lymphoblastic leukemia ALL (T-ALL) historically have had inferior outcomes compared with the children with precursor-B ALL (B-ALL). After 1995, the Children's Cancer Group (CCG) treated patients with B- and T-ALL according to the National Cancer Institute (NCI) risk criteria, basing risk stratification on age and white blood cell (WBC) count regardless of immunophenotype. The Pediatric Oncology Group (POG) treated all the patients with T-ALL on separate, generally more intensive protocols than those used to treat the patients with B-ALL. PROCEDURE: We compared the outcomes of children with T-ALL and NCI standard-risk (SR) criteria treated on CCG and POG trials between 1996 and 2005. CCGSR-ALL 1952 and 1991 enrolled 80 and 86 patients with T-ALL, respectively, utilizing a reduced intensity Berlin-Frankfurt-Münster backbone. Treatment was intensified for slow early responders and only patients with overt central nervous system leukemia received cranial irradiation. Eighty-four patients with T-ALL and SR features were enrolled on POG 9404 comprising more intensive therapy with all patients receiving cranial irradiation. RESULTS: The 7-year event-free survival (EFS) for patients with SR T-ALL on CCG 1952, CCG 1991, and POG 9404 were 74.1 ± 5.8%, 81.8 ± 5.3%, and 84.2 ± 4.3%, respectively (P = 0.18). Overall 7-year survivals were 86.1 ± 4.6%, 88.3 ± 4.4%, 89.1 ± 3.6%, respectively (P = 0.84). CONCLUSIONS: Comparable high rates of EFS and long-term survival were achieved with all three regimens, with the CCG regimens utilizing a less intensive chemotherapy backbone without prophylactic cranial irradiation for patients with SR T-ALL.
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