title: Intensification of chemotherapy using block therapies as consolidation and reinduction therapies for acute lymphoblastic leukemia during childhood.
abstract: Between April 1994 and March 1997, 143 children (age range, 1-15 years) with newly diagnosed acute lymphoblastic leukemia (ALL), except for those patients with t(9;22), were treated according to protocol-94 of the Osaka Childhood Leukemia Study Group. In this trial, the intensity of chemotherapy was enforced in the consolidation and reinduction phases by introducing AML-type block therapies consisting of concentrated administration of 4 to 6 drugs during 5 or 6 days. For patients in the higher risk groups, rotational combination chemotherapy was introduced following the early phase. A total of 124 children with B-cell precursor ALL (B-pre ALL) were classified into 3 groups, the ultrahigh-risk group (UHRG) (15 patients), the high-risk group (HRG) (61 patients), or the standard-risk group (SRG) (48 patients), based on age. leukocyte count, immunophenotype, central nervous system leukemia, response to treatment, and selected chromosomal abnormalities. The complete remission rate was 93%, and the 6-year event-free survival (EFS) rate was 79%+/-4%. EFS rates for the UHRG, HRG, and SRG groups were 67%+/-12%, 80%+/-6%, and 81%+/-6%, respectively. Nineteen patients with T-cell ALL were treated with the protocol for the UHRG. Thirteen patients (68%) attained complete remission, and the 6-year EFS rate was 55%+/-12%. Thus, intensification of chemotherapy improved the EFS rate and AML-type block therapies appeared to be effective as the consolidation and reinduction therapies for B-pre ALL.
authors.affiliation: Department of Developmental Medicine, Osaka University, Graduate School of Medicine, Suita, Japan. junhara@ped.med.osaka-u.ac.jp
authors.forename: J
authors.initials: J
authors.lastname: Hara
authors.forename: Y D
authors.initials: YD
authors.lastname: Park
authors.forename: A
authors.initials: A
authors.lastname: Yoshioka
authors.forename: K
authors.initials: K
authors.lastname: Yumura-Yagi
authors.forename: U
authors.initials: U
authors.lastname: Koudera
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authors.initials: G
authors.lastname: Hosoi
authors.forename: M
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authors.lastname: Sako
authors.forename: Y
authors.initials: Y
authors.lastname: Kosaka
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authors.lastname: Sano
authors.forename: H
authors.initials: H
authors.lastname: Misu
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authors.lastname: Mabuchi
authors.forename: N
authors.initials: N
authors.lastname: Aoyagi
authors.forename: M
authors.initials: M
authors.lastname: Yamamoto
authors.forename: A
authors.initials: A
authors.lastname: Tawa
authors.forename: H
authors.initials: H
authors.lastname: Miyata
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
authors.forename: M
authors.initials: M
authors.lastname: Kikkawa
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authors.initials: M
authors.lastname: Shimodera
authors.forename: K
authors.initials: K
authors.lastname: Kawa-Ha
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015448:Leukemia, B-Cell / Q000188:drug therapy; D015458:Leukemia, T-Cell / Q000188:drug therapy; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome