title: Results of Dana-Farber Cancer Institute Consortium protocols for children with newly diagnosed acute lymphoblastic leukemia (1981-1995).
abstract: The Dana-Farber Cancer Institute (DFCI) ALL consortium has been conducting clinical trials in childhood acute lymphoblastic leukemia (ALL) since 1981. The treatment backbone has included intensive, multi-agent remission induction, early intensification with weekly, high-dose asparaginase, cranial radiation for the majority of patients, frequent vincristine/ corticosteroid pulses during post-remission therapy, and for high-risk patients, doxorubicin during intensification. Between 1981 and 1995, 1,255 children with newly diagnosed ALL were evaluated on four consecutive protocols: 81-01 (1981-1985), 85-01 (1985-1987), 87-01 (1987-1991) and 91-01 (1991-1995). The 5-year event-free survival (EFS) rates (+/- standard error) for all patients by protocol were as follows: 74 +/- 3% (81-01), 78 +/- 3% (85-01), 77 +/- 2% (87-01) and 83 +/- 2% (91-01). The 5-year EFS rates ranged from 78 to 85% for patients with B-progenitor phenotype retrospectively classified as NCI standard-risk, 63-82% for NCI high-risk B-progenitor patients, and 70-79% for patients with T cell phenotype. Results of randomized studies revealed that neither high-dose methotrexate during induction (protocol 87-01) nor high-dose 6-mercaptopurine during intensification (protocol 91-01) were associated with improvement in EFS compared with standard doses. Current studies continue to focus on improving efficacy while minimizing acute and late toxicities.
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Insititute, Boston, MA 02115, USA.
authors.forename: L B
authors.initials: LB
authors.lastname: Silverman
authors.forename: L
authors.initials: L
authors.lastname: Declerck
authors.forename: R D
authors.initials: RD
authors.lastname: Gelber
authors.forename: V K
authors.initials: VK
authors.lastname: Dalton
authors.forename: B L
authors.initials: BL
authors.lastname: Asselin
authors.forename: R D
authors.initials: RD
authors.lastname: Barr
authors.forename: L A
authors.initials: LA
authors.lastname: Clavell
authors.forename: C A
authors.initials: CA
authors.lastname: Hurwitz
authors.forename: A
authors.initials: A
authors.lastname: Moghrabi
authors.forename: Y
authors.initials: Y
authors.lastname: Samson
authors.forename: M A
authors.initials: MA
authors.lastname: Schorin
authors.forename: J M
authors.initials: JM
authors.lastname: Lipton
authors.forename: H J
authors.initials: HJ
authors.lastname: Cohen
authors.forename: S E
authors.initials: SE
authors.lastname: Sallan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*