title: Long-term results of Dana-Farber Cancer Institute ALL Consortium protocols for children with newly diagnosed acute lymphoblastic leukemia (1985-2000).
abstract: The Dana-Farber Cancer Institute (DFCI) acute lymphoblastic leukemia (ALL) Consortium has been conducting multi-institutional clinical trials in childhood ALL since 1981. The treatment backbone has included 20-30 consecutive weeks of asparaginase during intensification and frequent vincristine/corticosteroid pulses during the continuation phase. Between 1985 and 2000, 1457 children aged 0-18 years were treated on four consecutive protocols: 85-01 (1985-1987), 87-01 (1987-1991), 91-01 (1991-1955) and 95-01 (1996-2000). The 10-year event-free survival (EFS)+/-s.e. by protocol was 77.9+/-2.8% (85-01), 74.2+/-2.3% (87-01), 80.8+/-2.1% (91-01) and 80.5+/-1.8% (95-01). Approximately 82% of patients treated in the 1980s and 88% treated in the 1990s were long-term survivors. Both EFS and overall survival (OS) rates were significantly higher for patients treated in the 1990s compared with the 1980s (P=0.05 and 0.01, respectively). On the two protocols conducted in the 1990s, EFS was 79-85% for T-cell ALL patients and 75-78% for adolescents (age 10-18 years). Results of randomized studies revealed that dexrazoxane prevented acute cardiac injury without adversely affecting EFS or OS in high-risk (HR) patients, and frequently dosed intrathecal chemotherapy was an effective substitute for cranial radiation in standard-risk (SR) patients. Current studies continue to focus on improving efficacy while minimizing acute and late toxicities.
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. lewis_silverman@dfci.harvard.edu
authors.forename: L B
authors.initials: LB
authors.lastname: Silverman
authors.forename: K E
authors.initials: KE
authors.lastname: Stevenson
authors.forename: J E
authors.initials: JE
authors.lastname: O'Brien
authors.forename: B L
authors.initials: BL
authors.lastname: Asselin
authors.forename: R D
authors.initials: RD
authors.lastname: Barr
authors.forename: L
authors.initials: L
authors.lastname: Clavell
authors.forename: P D
authors.initials: PD
authors.lastname: Cole
authors.forename: K M
authors.initials: KM
authors.lastname: Kelly
authors.forename: C
authors.initials: C
authors.lastname: Laverdiere
authors.forename: B
authors.initials: B
authors.lastname: Michon
authors.forename: M A
authors.initials: MA
authors.lastname: Schorin
authors.forename: C L
authors.initials: CL
authors.lastname: Schwartz
authors.forename: E W
authors.initials: EW
authors.lastname: O'Holleran
authors.forename: D S
authors.initials: DS
authors.lastname: Neuberg
authors.forename: H J
authors.initials: HJ
authors.lastname: Cohen
authors.forename: S E
authors.initials: SE
authors.lastname: Sallan
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016130:Immunophenotyping; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome