PURPOSE: Despite improved event-free survival of older children with acute lymphocytic leukemia (ALL), infants <1 year of age continue to have a very poor prognosis. A new therapy designed specifically for infants with ALL was initiated. PATIENTS AND METHODS: From 1984 until 1990, 82 eligible infants <1 year of age were entered on a Pediatric Oncology Group (POG) protocol 8493 for infant ALL. Compared to older patients, infants at diagnosis had more overt CNS leukemia (26%), higher initial WBC count (56% >50,000/microl), and a higher likelihood of CD-10 (CALLA) negative lymphoblasts (55%). A translocation involving chromosome 11 at band q23 was detected in 27 of 64 cytogenetically informative cases. Treatment was based upon two institutional pilot studies utilizing chemotherapy doses based upon body weight. Important components included remission induction with cyclophosphamide (Ctx), vincristine (Vcr), cytosine arabinoside (Ara-C), and prednisone (Pred) (COAP); consolidation therapy with teniposide (VM-26) and Ara-C; and continuation therapy with alternating pulses of COAP with VM-26/Ara-C separated by a methotrexate (Mtx) and 6-mercaptopurine (6-MP) backbone plus CNS therapy consisting of standard triple intrathecal therapy (TIT) (Mtx/hydrocortisone/Ara-C), which avoided the use of radiotherapy in this population. RESULTS: Seventy-six infants achieved a complete remission (93%). Fifty patients have relapsed: 35 isolated marrow relapses, five isolated CNS relapses, eight combined marrow and CNS relapses, and two other relapses. Actuarial event-free survival was 28% (SE = 5%) at 4 years. Infants >274 days (9 months) at diagnosis had a better outcome than those <274 days. CONCLUSIONS: This study represents a modest outcome improvement in comparison to previous experience with ALL for infants treated on POG trials. More effective therapy is still needed for infants with ALL.
PURPOSE: Despite improved event-free survival of older children with acute lymphocytic leukemia (ALL), infants <1 year of age continue to have a very poor prognosis. A new therapy designed specifically for infants with ALL was initiated. PATIENTS AND METHODS: From 1984 until 1990, 82 eligible infants <1 year of age were entered on a Pediatric Oncology Group (POG) protocol 8493 for infant ALL. Compared to older patients, infants at diagnosis had more overt CNS leukemia (26%), higher initial WBC count (56% >50,000/microl), and a higher likelihood of CD-10 (CALLA) negative lymphoblasts (55%). A translocation involving chromosome 11 at band q23 was detected in 27 of 64 cytogenetically informative cases. Treatment was based upon two institutional pilot studies utilizing chemotherapy doses based upon body weight. Important components included remission induction with cyclophosphamide (Ctx), vincristine (Vcr), cytosine arabinoside (Ara-C), and prednisone (Pred) (COAP); consolidation therapy with teniposide (VM-26) and Ara-C; and continuation therapy with alternating pulses of COAP with VM-26/Ara-C separated by a methotrexate (Mtx) and 6-mercaptopurine (6-MP) backbone plus CNS therapy consisting of standard triple intrathecal therapy (TIT) (Mtx/hydrocortisone/Ara-C), which avoided the use of radiotherapy in this population. RESULTS: Seventy-six infants achieved a complete remission (93%). Fifty patients have relapsed: 35 isolated marrow relapses, five isolated CNS relapses, eight combined marrow and CNS relapses, and two other relapses. Actuarial event-free survival was 28% (SE = 5%) at 4 years. Infants >274 days (9 months) at diagnosis had a better outcome than those <274 days. CONCLUSIONS: This study represents a modest outcome improvement in comparison to previous experience with ALL for infants treated on POG trials. More effective therapy is still needed for infants with ALL.
Authors: ZoAnn E Dreyer; Joanne M Hilden; Tamekia L Jones; Meenakshi Devidas; Naomi J Winick; Cheryl L Willman; Richard C Harvey; I-Ming Chen; Fred G Behm; Jeanette Pullen; Brent L Wood; Andrew J Carroll; Nyla A Heerema; Carolyn A Felix; Blaine Robinson; Gregory H Reaman; Wanda L Salzer; Stephen P Hunger; William L Carroll; Bruce M Camitta Journal: Pediatr Blood Cancer Date: 2014-11-14 Impact factor: 3.167
Authors: Wanda L Salzer; Tamekia L Jones; Meenakshi Devidas; ZoAnn E Dreyer; Lia Gore; Naomi J Winick; Lillian Sung; Elizabeth Raetz; Mignon L Loh; Cindy Y Wang; Paola De Lorenzo; Maria Grazia Valsecchi; Rob Pieters; William L Carroll; Stephen P Hunger; Joanne M Hilden; Patrick Brown Journal: Pediatr Blood Cancer Date: 2014-11-18 Impact factor: 3.167
Authors: Prakash Satwani; Harland Sather; Fevzi Ozkaynak; Nyla A Heerema; Kirk R Schultz; Jean Sanders; John Kersey; Virginia Davenport; Michael Trigg; Mitchell S Cairo Journal: Biol Blood Marrow Transplant Date: 2007-02 Impact factor: 5.742
Authors: P De Lorenzo; A V Moorman; R Pieters; Z E Dreyer; N A Heerema; A J Carroll; S P Hunger; R Harvey; C L Willman; M Devidas; M-G Valsecchi; C J Harrison Journal: Leukemia Date: 2013-09-27 Impact factor: 11.528
Authors: ZoAnn E Dreyer; Patricia A Dinndorf; Bruce Camitta; Harland Sather; Mei K La; Meenakshi Devidas; Joanne M Hilden; Nyla A Heerema; Jean E Sanders; Ron McGlennen; Cheryl L Willman; Andrew J Carroll; Fred Behm; Franklin O Smith; William G Woods; Kamar Godder; Gregory H Reaman Journal: J Clin Oncol Date: 2010-12-06 Impact factor: 44.544
Authors: Yazmín Gómez-Gómez; Jorge Organista-Nava; Mónica Virginia Saavedra-Herrera; Ana Bertha Rivera-Ramírez; Marco Antonio Terán-Porcayo; Luz Del Carmen Alarcón-Romero; Berenice Illades-Aguiar; Marco Antonio Leyva-Vázquez Journal: Exp Ther Med Date: 2012-01-09 Impact factor: 2.447