Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2010 Feb 1;28(4):648-54.
doi: 10.1200/JCO.2009.22.2950. Epub 2009 Oct 19.

Outcome of patients treated for relapsed or refractory acute lymphoblastic leukemia: a Therapeutic Advances in Childhood Leukemia Consortium study

Richard H Ko  1 , Lingyun Ji, Phillip Barnette, Bruce Bostrom, Raymond Hutchinson, Elizabeth Raetz, Nita L Seibel, Clare J Twist, Elena Eckroth, Richard Sposto, Paul S Gaynon, Mignon L Loh
Affiliations
Multicenter Study

Outcome of patients treated for relapsed or refractory acute lymphoblastic leukemia: a Therapeutic Advances in Childhood Leukemia Consortium study

Richard H Ko et al. J Clin Oncol. .

Abstract

Purpose: Despite improvements in treatment, approximately 20% of patients with acute lymphoblastic leukemia (ALL) experience relapse and do poorly. The Therapeutic Advances in Childhood Leukemia (TACL) Consortium was assembled to assess novel drugs for children with resistant leukemia. We hypothesize that novel agents and combinations that fail to improve baseline complete remission rates in comparable populations are unlikely to contribute to better outcomes and should be abandoned. We sought to define response rates and disease-free survival (DFS) rates in patients treated at TACL institutions, which could serve as a comparator for future studies.

Patients and methods: We performed a retrospective cohort review of patients with relapsed and refractory ALL previously treated at TACL institutions between the years of 1995 and 2004. Data regarding initial and relapsed disease characteristics, disease response, and survival were collected and compared with those of published reports.

Results: Complete remission (CR) rates (mean +/- SE) were 83% +/- 4% for early first marrow relapse, 93% +/- 3% for late first marrow relapse, 44% +/- 5% for second marrow relapse, and 27% +/- 6% for third marrow relapse. Five-year DFS rates in CR2 and CR3 were 27% +/- 4% and 15% +/- 7% respectively.

Conclusion: We generally confirm a 40% CR rate for second and subsequent relapse, but our remission rate for early first relapse seems better than that reported in the literature (83% v approximately 70%). Our data may allow useful modeling of an expected remission rate for any population of patients who experience relapse.

PubMed Disclaimer

Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Post recurrence disease-free survival after complete remission (CR) as function of (A) treatment attempt and of (B) duration of first CR (CR 1).
Fig A1.
Fig A1.
Complete remission (CR) rate of these 19 treatments was 10 of 15 second treatment attempts, two of two third treatment attempts, one of one fourth treatment attempt, and one of one fifth treatment attempt. Bars indicate SE.
Fig A2.
Fig A2.
Response to the second to ninth treatment attempts as a function of duration of prior complete remission (CR). Bars indicate SE.
See this image and copyright information in PMC

References

    1. Smith MA, Gloeckler-Ries LA, Gurney JG, et al. Bethesda, MD: National Cancer Institute; 2005. Leukemia: SEER Pediatric Monograph.
    1. Kersey JH. Fifty years of studies of the biology and therapy of childhood leukemia. Blood. 1997;90:4243–4251. - PubMed
    1. Feig SA, Ames MM, Sather HN, et al. Comparison of idarubicin to daunomycin in a randomized multidrug treatment of childhood acute lymphoblastic leukemia at first bone marrow relapse: A report from the Children's Cancer Group. Med Pediatr Oncol. 1996;27:505–514. - PubMed
    1. Henze G, Fengler R, Hartmann R, et al. Six-year experience with a comprehensive approach to the treatment of recurrent childhood acute lymphoblastic leukemia (ALL-REZ BFM 85): A relapse study of the BFM group. Blood. 1991;78:1166–1172. - PubMed
    1. Rivera GK, Zhou Y, Hancock ML, et al. Bone marrow recurrence after initial intensive treatment for childhood acute lymphoblastic leukemia. Cancer. 2005;103:368–376. - PubMed

Publication types

MeSH terms