title: Treatment for childhood acute lymphoblastic leukemia in Taiwan: Taiwan Pediatric Oncology Group ALL-2002 study emphasizing optimal reinduction therapy and central nervous system preventive therapy without cranial radiation.
abstract: Reinduction therapy has improved the outcomes in children with acute lymphoblastic leukemia (ALL). We sought to determine the optimal course(s) of reinduction therapy for standard-risk (SR, or "low-risk" in other groups) patients. Also, we evaluated outcomes using triple intrathecal therapy without cranial radiation (CrRT) for central nervous system (CNS) preventive therapy.
  
  
  
  From 2002 to 2012, all newly diagnosed children with ALL in Taiwan were enrolled in Taiwan Pediatric Oncology Group ALL-2002 protocol. SR patients were randomized to receive single or double reinduction courses. The patients enrolled before 2009 received CrRT, while those enrolled later did not. The Kaplan-Meier method was used to estimate survival rates and the difference between two groups was compared by the two-sided log-rank test.
  
  
  
  In 1,366 eligible patients, the 5-year overall survival (OS) was 81.6 ± 1.1% (standard error) and 5-year event-free survival (EFS) was 74.3 ± 1.2%. In SR patients, the 5-year OS for one and two reinduction courses was 91.6 ± 2.1% and 93.7 ± 1.8%, respectively, and the 5-year EFS was 85.2 ± 2.7% and 89.8 ± 2.3%, respectively. There were no significant differences in survival between these two groups. Patients with MLL or BCR-ABL1 had the worst outcomes: 5-year EFS was 23.4 and 31.8% and 5-year OS was 28.6 and 44.7%, respectively. There was no significant difference in CNS relapse or survival between the era with or without CrRT.
  
  
  
  For SR patients, one-course reinduction was adequate. Triple intrathecal therapy alone successfully prevented CNS relapse.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
authors.forename: Meng-Ju
authors.initials: MJ
authors.lastname: Li
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Mackay Medical College, Taipei, Taiwan.
authors.forename: Hsi-Che
authors.initials: HC
authors.lastname: Liu
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hsiu-Ju
authors.initials: HJ
authors.lastname: Yen
authors.affiliation: Department of Hematology-Oncology, Chang Gung Children's Hospital-Linkou, Taoyuan, Taiwan.
authors.forename: Tang-Her
authors.initials: TH
authors.lastname: Jaing
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Dong-Tsamn
authors.initials: DT
authors.lastname: Lin
authors.affiliation: Department of Hematology-Oncology, Chang Gung Children's Hospital-Linkou, Taoyuan, Taiwan.
authors.forename: Chao-Ping
authors.initials: CP
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Kai-Hsin
authors.initials: KH
authors.lastname: Lin
authors.affiliation: Department of Hematology-Oncology, Chang Gung Children's Hospital-Linkou, Taoyuan, Taiwan.
authors.forename: Iou-Jih
authors.initials: IJ
authors.lastname: Hung
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Shiann-Tarng
authors.initials: ST
authors.lastname: Jou
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Meng-Yao
authors.initials: MY
authors.lastname: Lu
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsiao
authors.affiliation: Division of Pediatric Hematology & Oncology, China Medical University Children's Hospital, Taichung, Taiwan.|Department of Biotechnology, Asia University, Wufeng, Taichung, Taiwan.
authors.forename: Ching-Tien
authors.initials: CT
authors.lastname: Peng
authors.affiliation: Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan.
authors.forename: Tai-Tsung
authors.initials: TT
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Shih-Chung
authors.initials: SC
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ming-Tsan
authors.initials: MT
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Jiann-Shiuh
authors.initials: JS
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Te-Kau
authors.initials: TK
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Giun-Yi
authors.initials: GY
authors.lastname: Hung
authors.affiliation: Division of Pediatric Hematology & Oncology, China Medical University Children's Hospital, Taichung, Taiwan.
authors.forename: Kang-Hsi
authors.initials: KH
authors.lastname: Wu
authors.affiliation: Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Yung-Li
authors.initials: YL
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Hsiu-Hao
authors.initials: HH
authors.lastname: Chang
authors.affiliation: Department of Hematology-Oncology, Chang Gung Children's Hospital-Linkou, Taoyuan, Taiwan.
authors.forename: Shih-Hsiang
authors.initials: SH
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Mackay Medical College, Taipei, Taiwan.
authors.forename: Ting-Chi
authors.initials: TC
authors.lastname: Yeh
authors.affiliation: Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Chao-Neng
authors.initials: CN
authors.lastname: Cheng
authors.affiliation: Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Pei-Chin
authors.initials: PC
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Shyh-Shin
authors.initials: SS
authors.lastname: Chiou
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Jiunn-Ming
authors.initials: JM
authors.lastname: Sheen
authors.affiliation: Department of Pediatrics, Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan.
authors.forename: Shin-Nan
authors.initials: SN
authors.lastname: Cheng
authors.affiliation: Department of Pediatrics, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.
authors.forename: Shu-Huey
authors.initials: SH
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.|School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Wan-Ling
authors.initials: WL
authors.lastname: Ho
authors.affiliation: Department of Pediatrics, Chung Shan Medical University Hospital, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Chao
authors.affiliation: Division of Pediatric Hematology and Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Rong-Long
authors.initials: RL
authors.lastname: Chen
authors.affiliation: Division of Pediatric Hematology and Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Bow-Wen
authors.initials: BW
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Wanfang Hospital Taipei Medical University, Taipei, Taiwan.
authors.forename: Jinn-Li
authors.initials: JL
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Yuh-Lin
authors.initials: YL
authors.lastname: Hsieh
authors.affiliation: Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Liao
authors.affiliation: Department of Pediatrics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
authors.forename: Shang-Hsien
authors.initials: SH
authors.lastname: Yang
authors.affiliation: Childhood Cancer Foundation, Taipei, Taiwan.
authors.forename: Wan-Hui
authors.initials: WH
authors.lastname: Chang
authors.affiliation: Childhood Cancer Foundation, Taipei, Taiwan.
authors.forename: Yu-Mei Y
authors.initials: YY
authors.lastname: Chao
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Mackay Medical College, Taipei, Taiwan.
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Liang
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009367:Neoplasm Staging; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
keywords: CNS prophylaxis; childhood acute lymphoblastic leukemia; reinduction therapy; standard risk; triple intrathecal therapy