PURPOSE: Here we report the results of a nationwide cooperative study in the Netherlands on acute lymphoblastic leukemia (ALL) in children. The aim of the study was to improve the cure rate and to minimize side effects in a group of non-high-risk ALL patients, especially with regard to the CNS. A second aim was to study potential prognostic factors. METHODS: Children (age 0 to 15 years) with non-high-risk ALL (WBC count < 50 x 10(9)/L, no mediastinal mass, no B-cell phenotype, and no CNS involvement) were treated with a uniform protocol, ALL VI. The treatment protocol used 6-week induction regimen with three drugs (vincristine, dexamethasone, and asparaginase), three weekly doses of intravenous (IV) medium high-dose methotrexate (2 g/m2), and 2-year maintenance therapy that consisted of alternating 5-week periods of methotrexate and mercaptopurine and 2-week periods of vincristine and dexamethasone. In the first year of maintenance, triple intrathecal therapy was administered every 7 weeks. RESULTS: From December 1, 1984 until July 1, 1988, 291 children with ALL were diagnosed; 206 were categorized as non-high-risk (71%), and 190 were treated according to protocol ALL VI. At 8 years, the event-free survival (EFS) rate was 81% (SE = 3%) and survival rate 85% (SE = 2.9%); the median follow-up time was 7.3 years (range, 36 to 117 months). The CNS relapse rate was 1.1% (two of 184 patients who achieved a complete remission [CR]). The only factor found to be of negative prognostic importance in terms of EFS (P = .05) was a positive acid phosphatase reaction. CONCLUSION: For children with non-high-risk ALL, the combination of IV medium high-dose methotrexate (2 g/m2 times three), triple intrathecal therapy in the first year of maintenance treatment, and the use of dexamethasone for induction and pulses during maintenance treatment has proved to be highly effective, especially in the prevention of CNS relapse. A high cure rate was achieved without the use of anthracyclines, alkylating agents, and cranial irradiation.
PURPOSE: Here we report the results of a nationwide cooperative study in the Netherlands on acute lymphoblastic leukemia (ALL) in children. The aim of the study was to improve the cure rate and to minimize side effects in a group of non-high-risk ALL patients, especially with regard to the CNS. A second aim was to study potential prognostic factors. METHODS:Children (age 0 to 15 years) with non-high-risk ALL (WBC count < 50 x 10(9)/L, no mediastinal mass, no B-cell phenotype, and no CNS involvement) were treated with a uniform protocol, ALL VI. The treatment protocol used 6-week induction regimen with three drugs (vincristine, dexamethasone, and asparaginase), three weekly doses of intravenous (IV) medium high-dose methotrexate (2 g/m2), and 2-year maintenance therapy that consisted of alternating 5-week periods of methotrexate and mercaptopurine and 2-week periods of vincristine and dexamethasone. In the first year of maintenance, triple intrathecal therapy was administered every 7 weeks. RESULTS: From December 1, 1984 until July 1, 1988, 291 children with ALL were diagnosed; 206 were categorized as non-high-risk (71%), and 190 were treated according to protocol ALL VI. At 8 years, the event-free survival (EFS) rate was 81% (SE = 3%) and survival rate 85% (SE = 2.9%); the median follow-up time was 7.3 years (range, 36 to 117 months). The CNS relapse rate was 1.1% (two of 184 patients who achieved a complete remission [CR]). The only factor found to be of negative prognostic importance in terms of EFS (P = .05) was a positive acid phosphatase reaction. CONCLUSION: For children with non-high-risk ALL, the combination of IV medium high-dose methotrexate (2 g/m2 times three), triple intrathecal therapy in the first year of maintenance treatment, and the use of dexamethasone for induction and pulses during maintenance treatment has proved to be highly effective, especially in the prevention of CNS relapse. A high cure rate was achieved without the use of anthracyclines, alkylating agents, and cranial irradiation.
Authors: Judith L Kok; Jop C Teepen; Flora E van Leeuwen; Wim J E Tissing; Sebastian J C M M Neggers; Helena J van der Pal; Jacqueline J Loonen; Dorine Bresters; Birgitta Versluys; Marry M van den Heuvel-Eibrink; Eline van Dulmen-den Broeder; Margriet van der Heiden-van der Loo; Berthe M P Aleman; Laurien A Daniels; Cornelis J A Haasbeek; Bianca Hoeben; Geert O Janssens; John H Maduro; Foppe Oldenburger; Caroline van Rij; Robbert J H A Tersteeg; Michael Hauptmann; Leontien C M Kremer; Cécile M Ronckers Journal: Neuro Oncol Date: 2019-02-19 Impact factor: 12.300
Authors: Jill H Simmons; Eric J Chow; Elizabeth Koehler; Adam Esbenshade; Lesley-Ann Smith; Jean Sanders; Debra Friedman Journal: Pediatr Blood Cancer Date: 2010-12-22 Impact factor: 3.167
Authors: Laura B Ramsey; Stan Pounds; Cheng Cheng; Xueyuan Cao; Wenjian Yang; Colton Smith; Seth E Karol; Chengcheng Liu; John C Panetta; Hiroto Inaba; Jeffrey E Rubnitz; Monika L Metzger; Raul C Ribeiro; John T Sandlund; Sima Jeha; Ching-Hon Pui; William E Evans; Mary V Relling Journal: Pharmacogenet Genomics Date: 2017-08 Impact factor: 2.089
Authors: Mariël L te Winkel; Robert D van Beek; Sabine M P F de Muinck Keizer-Schrama; André G Uitterlinden; Wim C J Hop; Rob Pieters; Marry M van den Heuvel-Eibrink Journal: Haematologica Date: 2009-12-16 Impact factor: 9.941