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Randomized Controlled Trial
. 2015 Mar;62(3):419-26.
doi: 10.1002/pbc.25322. Epub 2014 Nov 14.

Intensified chemotherapy without SCT in infant ALL: results from COG P9407 (Cohort 3)

ZoAnn E Dreyer  1 , Joanne M Hilden, Tamekia L Jones, Meenakshi Devidas, Naomi J Winick, Cheryl L Willman, Richard C Harvey, I-Ming Chen, Fred G Behm, Jeanette Pullen, Brent L Wood, Andrew J Carroll, Nyla A Heerema, Carolyn A Felix, Blaine Robinson, Gregory H Reaman, Wanda L Salzer, Stephen P Hunger, William L Carroll, Bruce M Camitta
Affiliations
Randomized Controlled Trial

Intensified chemotherapy without SCT in infant ALL: results from COG P9407 (Cohort 3)

ZoAnn E Dreyer et al. Pediatr Blood Cancer. 2015 Mar.

Abstract

Background: Infants with acute lymphoblastic leukemia (ALL) present with aggressive disease and a poor prognosis. Early relapse within 6-9 months of diagnosis is common. Approximately 75% of infants have MLL-rearranged (MLL-R) ALL with event free survival (EFS) ranging from 20% to 30%. Children's Oncology Group (COG) P9407 used shortened (46 weeks), intensified therapy to address early relapse and poor EFS.

Procedure: P9407 therapy was modified three times for induction toxicity resulting in three cohorts of therapy. One hundred forty-seven infants were enrolled in the third cohort.

Results: We report an overall 5-year EFS and OS of 42.3 ± 6% and 52.9 ± 6.5% respectively. Poor prognostic factors included age ≤90 days at diagnosis, MLL-R ALL and white cell count ≥50,000/μl. For infants ≤90 days of age, the 5-year EFS was 15.5 ± 10.1% and 48.5 ± 6.7% for those >90 days (P < 0.0001). Among infants >90 days of age, 5-year EFS rates were 43.8 ± 8% for MLL-R versus 69.1 ± 13.6% for MLL-germline ALL (P < 0.0001).

Conclusions: Age ≤90 days at diagnosis was the most important prognostic factor. Despite shortened therapy with early intensification, EFS remained less than 50% overall in MLL-R ALL.

Keywords: COG P9407; Intensified therapy without SCT; infant ALL.

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Conflict of interest statement

The following authors have nothing to disclose: ZoAnn E. Dreyer, Joanne M. Hilden, Meenakshi Devidas, Cheryl L. Willman, I-Ming Chen, Brent L. Wood, Andrew J. Carroll, Nyla A. Heerema, Blaine Robinson, Stephen P. Hunger, Fred G. Behm, William L. Carroll, Bruce M. Camitta, Jeanette Pullen, Tamekia L. Jones, Gregory H. Reaman, Wanda L. Salzer, Naomi J. Winick, Richard C. Harvey. Carolyn A. Felix has the following disclosure: Carolyn A. Felix owns the following patent: Methods and Kits for Analysis of Chromosomal Rearrangements Associated with Leukemia – US Patent #6,368,791 (issued April 9, 2002).

Figures

Figure 1
Figure 1. Overall survival (OS) and event free survival (EFS) for Cohort 3
The OS and EFS are presented.
Figure 2
Figure 2. EFS curves for Cohort 3: ≤90 days vs. > 90 days at diagnosis
The EFS is compared by age at diagnosis: ≤90 days vs. > 90 days.
Figure 3
Figure 3. EFS curves for Cohort 3: MLL vs. age at diagnosis
The EFS using MLL status vs. age at diagnosis.
See this image and copyright information in PMC

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