title: [Intensification of the initial treatment in acute lymphoblastic leukemias of middle and high risk in children].
abstract: The aim of study LAL 17/84 was to reduce the number of relapses by intensifying initial treatment. Patients were classified as high (HR) and standard-risk (SR) groups following the established risk index. Early response, after 2 weeks of treatment was also considered. SR protocol includes a ten-week induction and CNS prophylaxis phase: in the first 5 weeks, prednisolone (PRED), vincristine (VCR), daunorubicin (DAUNO) and asparaginase (ASPAR) are given; in the last 5 weeks two intravenous infusions of Ara-C and three of intermediate dose (ID) methotrexate (MTX) are administered simultaneously with 5 it injections of both drugs. CNS prophylaxis is completed with 5 further it injections: one at the beginning and 4 at monthly intervals from the 3rd to the 6th months. In the HR protocol, the initial phase lasts 16 weeks: in the first 5 the same drugs as in SR are used but doses of PRED and ASPAR are higher. CNS prophylaxis includes holocranial radiotherapy (18 Gy), 2 iv infusions of Ara-C and a further 2 of MTX ID and 6 it doses of MTX and Ara-C. Finally, a consolidation phase of PRED, VCR (3 doses), tenoposide (3 doses) and cyclophosphamide is given. Complementary chemotherapy in both protocols consists of daily mercaptopurine and weekly MTX for 2 years; moreover, the randomized half of the patients received monthly reinforcements with PRED, VCR (and DAUNO in HR group) for 4 months. Between Oct. 83 and Nov. 87,87 patients with ages between 3 months and 15 years were enrolled; 86 are evaluable. All achieved remission.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Servicio de Radioterapia, Hospital Infantil Valle de Hebrón, Universidad Autónoma, Barcelona.
authors.forename: J J
authors.initials: JJ
authors.lastname: Ortega Aramburu
authors.forename: G
authors.initials: G
authors.lastname: Javier Manchón
authors.forename: T
authors.initials: T
authors.lastname: Olivé Oliveras
authors.forename: J M
authors.initials: JM
authors.lastname: Montagut Dueso
authors.forename: G
authors.initials: G
authors.lastname: Acebedo Lerzundi
authors.forename: N
authors.initials: N
authors.lastname: Torán Fuentes
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000517:prevention & control* / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D003561:Cytarabine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D012074:Remission Induction; D012307:Risk Factors
chemical_list: D003561:Cytarabine; D008727:Methotrexate
vernacular_title: Intensificación del tratamiento inicial en las leucemias agudas linfoblásticas de medio y alto riesgo en el niño.