title: Outcome of congenital acute lymphoblastic leukemia treated on the Interfant-99 protocol.
abstract: Acute lymphoblastic leukemia (ALL) diagnosed in the first month of life (congenital ALL) is very rare. Although congenital ALL is often assumed to be fatal, no studies have been published on outcome except for case reports. The present study reports the outcome of 30 patients with congenital ALL treated with the uniform Interfant-99 protocol, a hybrid regimen combining ALL treatment with elements designed for treatment of acute myeloid leukemia. Congenital ALL was characterized by a higher white blood cell count and a strong trend for higher incidence of MLL rearrangements and CD10-negative B-lineage ALL compared with older infants. Induction failure rate was 13% and not significantly different from that in older infants (7%, P = .14), but relapse rate was significantly higher in congenital ALL patients (2-year cumulative incidence [SE] was 60.0 [9.3] vs 34.2 [2.3], P < .001). Two-year event-free survival and survival of congenital ALL patients treated with this protocol was 20% (SE 9.1%). Early death in complete remission and treatment delays resulting from toxicity were not different. The survival of 17% after last follow-up, combined with a toxicity profile comparable with that in older infants, justifies treating congenital ALL with curative intent. This trial was registered at www.clinicaltrials.gov as no. NCT 00015873, and at www.controlled-trials.com as no. ISRCTN24251487.
authors: Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors: Marieke H
authors: MH
authors: van der Linden
authors: Maria Grazia
authors: MG
authors: Valsecchi
authors: Paola
authors: P
authors: De Lorenzo
authors: Anja
authors: A
authors: Möricke
authors: Gritta
authors: G
authors: Janka
authors: Thierry M
authors: TM
authors: Leblanc
authors: Maria
authors: M
authors: Felice
authors: Andrea
authors: A
authors: Biondi
authors: Myriam
authors: M
authors: Campbell
authors: Ian
authors: I
authors: Hann
authors: Jeffrey E
authors: JE
authors: Rubnitz
authors: Jan
authors: J
authors: Stary
authors: Tomasz
authors: T
authors: Szczepanski
authors: Ajay
authors: A
authors: Vora
authors: Alina
authors: A
authors: Ferster
authors: Liisa
authors: L
authors: Hovi
authors: Lewis B
authors: LB
authors: Silverman
authors: Rob
authors: R
authors: Pieters
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001402:B-Lymphocytes; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D015321:Gene Rearrangement; D011495:Histone-Lysine N-Methyltransferase; D006801:Humans; D007231:Infant, Newborn; D007958:Leukocyte Count; D008297:Male; D051788:Myeloid-Lymphoid Leukemia Protein / Q000235:genetics; D015260:Neprilysin; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D012008:Recurrence; D012074:Remission Induction; D015996:Survival Rate
chemical_list: C497422:KMT2A protein, human; D051788:Myeloid-Lymphoid Leukemia Protein; D011495:Histone-Lysine N-Methyltransferase; D015260:Neprilysin