Efficacy of high-dose methotrexate in childhood acute lymphocytic leukemia: Analysis by contemporary risk classifications

M. Abromowitch, J. Ochs, C. H. Pui, D. Fairclough, S. B. Murphy, G. K. Rivera

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

High-dose methotrexate (HDMTX) added to a basic regimen of chemotherapy proved superior to cranial irradiation and sequentially administered drug pairs (RTSC) in prolonging complete remissions in children with 'standard-risk' acute lymphocytic leukemia. To extend this result to more contemporary risk groups, we reclassified the patients according to methods of the Pediatric Oncology Group (POG), the Childrens Cancer Study Group (CCG), the Rome workshop, and St Jude Total Therapy Study XI. By life table analysis, 70% to 78% of patients with a favorable prognosis would remain in continuous complete remission (CCR) at 4 years if treated with HDMTX. Uniformly lower CCR rates could be expected with RTSC, especially in St Jude better-risk patients. HDMTX also would show greater efficacy than RTSC in the CCG average-risk and POG poor-risk groups, but the results appear inferior to those being achieved with intensified regimens for high-risk leukemia. Although both therapies would provide adequate CNS prophylaxis in favorable-risk groups, RTSC would offer greater protection in patients classified as being in a worse-risk group by St Jude criteria. We conclude that HDMTX-based therapy, as described in this report, would be most effective in patients with a presenting leukocyte count of < 25 x 109/L, of the white race, aged 2 to 10 years, and having leukemic cell hyperdiploidy without translocations.

Original languageEnglish (US)
Pages (from-to)866-869
Number of pages4
JournalBlood
Volume71
Issue number4
StatePublished - Jan 1 1988

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Methotrexate
Pediatrics
Oncology
Cranial Irradiation
Polyploidy
Life Tables
Chemotherapy
Leukocyte Count
Neoplasms
Leukemia
Therapeutics
Irradiation
Education
Drug Therapy
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Abromowitch, M., Ochs, J., Pui, C. H., Fairclough, D., Murphy, S. B., & Rivera, G. K. (1988). Efficacy of high-dose methotrexate in childhood acute lymphocytic leukemia: Analysis by contemporary risk classifications. Blood, 71(4), 866-869.

Efficacy of high-dose methotrexate in childhood acute lymphocytic leukemia : Analysis by contemporary risk classifications. / Abromowitch, M.; Ochs, J.; Pui, C. H.; Fairclough, D.; Murphy, S. B.; Rivera, G. K.

In: Blood, Vol. 71, No. 4, 01.01.1988, p. 866-869.

Research output: Contribution to journalArticle

Abromowitch, M, Ochs, J, Pui, CH, Fairclough, D, Murphy, SB & Rivera, GK 1988, 'Efficacy of high-dose methotrexate in childhood acute lymphocytic leukemia: Analysis by contemporary risk classifications', Blood, vol. 71, no. 4, pp. 866-869.
Abromowitch, M. ; Ochs, J. ; Pui, C. H. ; Fairclough, D. ; Murphy, S. B. ; Rivera, G. K. / Efficacy of high-dose methotrexate in childhood acute lymphocytic leukemia : Analysis by contemporary risk classifications. In: Blood. 1988 ; Vol. 71, No. 4. pp. 866-869.
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