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Randomized Controlled Trial
. 2008 Mar 1;111(5):2548-55.
doi: 10.1182/blood-2007-02-070342. Epub 2007 Nov 26.

Early postinduction intensification therapy improves survival for children and adolescents with high-risk acute lymphoblastic leukemia: a report from the Children's Oncology Group

Nita L Seibel  1 , Peter G Steinherz, Harland N Sather, James B Nachman, Cynthia Delaat, Lawrence J Ettinger, David R Freyer, Leonard A Mattano Jr, Caroline A Hastings, Charles M Rubin, Kathy Bertolone, Janet L Franklin, Nyla A Heerema, Torrey L Mitchell, Allan F Pyesmany, Mei K La, Cheryl Edens, Paul S Gaynon
Affiliations
Randomized Controlled Trial

Early postinduction intensification therapy improves survival for children and adolescents with high-risk acute lymphoblastic leukemia: a report from the Children's Oncology Group

Nita L Seibel et al. Blood. .

Abstract

Longer and more intensive postinduction intensification (PII) improved the outcome of children and adolescents with "higher risk" acute lymphoblastic leukemia (ALL) and a slow marrow response to induction therapy. In the Children's Cancer Group study (CCG-1961), we tested longer versus more intensive PII, using a 2 x 2 factorial design for children with higher risk ALL and a rapid marrow response to induction therapy. Between November 1996 and May 2002, 2078 children and adolescents with newly diagnosed ALL (1 to 9 years old with white blood count 50 000/mm3 or more, or 10 years of age or older with any white blood count) were enrolled. After induction, 1299 patients with marrow blasts less than or equal to 25% on day 7 of induction (rapid early responders) were randomized to standard or longer duration (n = 651 + 648) and standard or increased intensity (n = 649 + 650) PII. Stronger intensity PII improved event-free survival (81% vs 72%, P < .001) and survival (89% vs 83%, P = .003) at 5 years. Differences were most apparent after 2 years from diagnosis. Longer duration PII provided no benefit. Stronger intensity but not prolonged duration PII improved outcome for patients with higher-risk ALL. This study is registered at http://clinicaltrials.gov as NCT00002812.

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Figures

Figure 1
Figure 1
Patient enrollment in CCG-1961.
Figure 2
Figure 2
Event-free survival during 5 years of follow-up in patients with ALL, according to the type of postinduction chemotherapy.
Figure 3
Figure 3
Overall survival during 5 years of follow-up in patients with ALL, according to the type of postinduction chemotherapy.
Figure 4
Figure 4
Event-free survival during 5 years of follow-up in patients with ALL, according to the duration of postinduction chemotherapy.
Figure 5
Figure 5
Comparison of event-free survival between historical CCG HR RER patients and RER patients treated with increased intensity postinduction intensification.
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References

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