title: Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy.
abstract: To improve outcome in childhood acute lymphoblastic leukaemia (ALL), a stratified, randomised study of extended intensified chemotherapy was done. 358 evaluable patients received remission reinforcement therapy (teniposide, cytarabine, high-dose methotrexate) added to a four-drug induction regimen. Those achieving complete remission were randomised on the basis of risk group assignment to conventional continuation treatment or to four pairs of drugs rotated weekly or every 6 weeks. All patients received intrathecal chemotherapy; higher-risk patients also received 1800 cGy cranial irradiation after 1 year of remission. Complete remission was induced in 96% of the patients. At median follow-up of 40 (range 19-73) months, 4-year event-free survival (SE) was 73 (4)% overall, 81 (6)% in the lower-risk group (n = 110), and 69 (5)% in the higher-risk group (n = 248). Outcome within risk groups was not significantly affected by the speed of rotation of drug pairs during continuation treatment. Various high-risk subgroups had apparently improved responses to this treatment. This intensified chemotherapy may cure 69-77% of children with ALL.
authors.affiliation: Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee 38101-0318.
authors.forename: G K
authors.initials: GK
authors.lastname: Rivera
authors.forename: S C
authors.initials: SC
authors.lastname: Raimondi
authors.forename: M L
authors.initials: ML
authors.lastname: Hancock
authors.forename: F G
authors.initials: FG
authors.lastname: Behm
authors.forename: C H
authors.initials: CH
authors.lastname: Pui
authors.forename: M
authors.initials: M
authors.lastname: Abromowitch
authors.forename: J
authors.initials: J
authors.lastname: Mirro
authors.forename: J S
authors.initials: JS
authors.lastname: Ochs
authors.forename: A T
authors.initials: AT
authors.lastname: Look
authors.forename: D L
authors.initials: DL
authors.lastname: Williams
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D012074:Remission Induction / Q000379:methods; D012307:Risk Factors; D013997:Time Factors