Outcome of Children with Standard-Risk T-Lineage Acute Lymphoblastic Leukemia--Comparison among Different Treatment Strategies.
BACKGROUND
Children with T-lineage acute lymphoblastic leukemia ALL (T-ALL) historically have had inferior outcomes compared with the children with precursor-B ALL (B-ALL). After 1995, the Children's Cancer Group (CCG) treated patients with B- and T-ALL according to the National Cancer Institute (NCI) risk criteria, basing risk stratification on age and white blood cell (WBC) count regardless of immunophenotype. The Pediatric Oncology Group (POG) treated all the patients with T-ALL on separate, generally more intensive protocols than those used to treat the patients with B-ALL.


METHODS
We compared the outcomes of children with T-ALL and NCI standard-risk (SR) criteria treated on CCG and POG trials between 1996 and 2005. CCG SR-ALL 1952 and 1991 enrolled 80 and 86 patients with T-ALL, respectively, utilizing a reduced intensity Berlin-Frankfurt-Münster backbone. Treatment was intensified for slow early responders and only patients with overt central nervous system leukemia received cranial irradiation. Eighty-four patients with T-ALL and SR features were enrolled on POG 9404 comprising more intensive therapy with all patients receiving cranial irradiation.


RESULTS
The 7-year event-free survival (EFS) for patients with SR T-ALL on CCG 1952, CCG 1991, and POG 9404 were 74.1 ± 5.8%, 81.8 ± 5.3%, and 84.2 ± 4.3%, respectively (P = 0.18). Overall 7-year survivals were 86.1 ± 4.6%, 88.3 ± 4.4%, 89.1 ± 3.6%, respectively (P = 0.84).


CONCLUSIONS
Comparable high rates of EFS and long-term survival were achieved with all three regimens, with the CCG regimens utilizing a less intensive chemotherapy backbone without prophylactic cranial irradiation for patients with SR T-ALL.
Rainbow Babies & Children's Hospital, Division of Hematology-Oncology, Case Western Reserve University, Cleveland, Ohio.
Yousif
Y
Matloub
Doernbecher Children's Hospital, Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon.
Linda
L
Stork
Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York.
Barbara
B
Asselin
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Stephen P
SP
Hunger
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Michael
M
Borowitz
Children's Foundation Research Institute, University of Tennessee Health Science Center, Memphis, Tennessee.
Tamekia
T
Jones
Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
Bruce
B
Bostrom
Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio.|Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio.|Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
Julie M
JM
Gastier-Foster
Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio.
Nyla A
NA
Heerema
Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama.
Andrew
A
Carroll
Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
Naomi
N
Winick
New York University Cancer Institute, New York, New York.
William L
WL
Carroll
Midwest Center for Cancer and Blood Disorders, Pediatric Hematology-Oncology, Milwaukee, Wisconsin.
Bruce
B
Camitta
Department of Biostatistics, Colleges of Medicine, Public Health & Health Professions, Children's University of Florida, Gainsville, Florida.
Meenakshi
M
Devidas
Division of Hematology-Oncology, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California.
Paul S
PS
Gaynon
D059248:Chemoradiotherapy; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome
T-cell leukemia; childhood acute leukemia; childhood leukemia