Failure of Late Intensification Therapy to Improve a Poor Result in Childhood Lymphoblastic Leukemia

Ching Hon Pui, Rhomes J.A. Aur, W. Paul Bowman, Gary V. Dahl, Richard K. Dodge, Stephen L. George, Judith Ochs, David K. Kalwinsky, Minnie Abromowitch, H. Omar Hustu, Joseph V. Simone

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Abstract

This clinical study, begun in 1975, tested the efficacy of early and delayed intensification treatments in children with acute lymphoblastic leukemia. Regardless of presenting features, all patients received 4 weeks of conventional induction therapy with daily prednisone and weekly vincristine and daunorubicin. One-third were randomized to receive, in addition, two doses of asparaginase during induction therapy, while another one-third received four doses of both asparaginase and cytarabine after remission induction. Preventive central nervous system therapy uniformly included 2400 rads cranial irradiation and five doses of intrathecal methotrexate. Remissions were maintained with daily p.o. mercaptopurine and weekly i.v. methotrexate. Of the 277 assessable patients, 254 (92%) entered complete remission, and 102 (37%) remain clinically free of leukemia for 4.6 to 8.0 years (median, 6.3 years). The three treatment groups showed no significant differences in either remission induction rate or outcome, even when the analysis was based on risk assignment. A “late intensification phase of therapy, added to the maintenance protocol for 65 patients who had been in continuous complete remission for 14 to 30 months, failed to extend remission durations, as judged from statistical comparison with matched controls (p = 0.84). When tested as a time-dependent covariate in the Cox proportional-hazards model, delayed intensification again showed no important effect on duration of complete remission. We conclude that limited early or aggressive late intensification of therapy, as described here, does not improve outcome in childhood acute lymphoblastic leukemia.

Original languageEnglish (US)
Pages (from-to)3593-3598
Number of pages6
JournalCancer Research
Volume44
Issue number8
StatePublished - Aug 1 1984

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Remission Induction
Asparaginase
Methotrexate
Therapeutics
Cranial Irradiation
6-Mercaptopurine
Daunorubicin
Cytarabine
Vincristine
Prednisone
Proportional Hazards Models
Leukemia
Central Nervous System
Maintenance

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Pui, C. H., Aur, R. J. A., Bowman, W. P., Dahl, G. V., Dodge, R. K., George, S. L., ... Simone, J. V. (1984). Failure of Late Intensification Therapy to Improve a Poor Result in Childhood Lymphoblastic Leukemia. Cancer Research, 44(8), 3593-3598.

Failure of Late Intensification Therapy to Improve a Poor Result in Childhood Lymphoblastic Leukemia. / Pui, Ching Hon; Aur, Rhomes J.A.; Bowman, W. Paul; Dahl, Gary V.; Dodge, Richard K.; George, Stephen L.; Ochs, Judith; Kalwinsky, David K.; Abromowitch, Minnie; Hustu, H. Omar; Simone, Joseph V.

In: Cancer Research, Vol. 44, No. 8, 01.08.1984, p. 3593-3598.

Research output: Contribution to journalArticle

Pui, CH, Aur, RJA, Bowman, WP, Dahl, GV, Dodge, RK, George, SL, Ochs, J, Kalwinsky, DK, Abromowitch, M, Hustu, HO & Simone, JV 1984, 'Failure of Late Intensification Therapy to Improve a Poor Result in Childhood Lymphoblastic Leukemia', Cancer Research, vol. 44, no. 8, pp. 3593-3598.
Pui CH, Aur RJA, Bowman WP, Dahl GV, Dodge RK, George SL et al. Failure of Late Intensification Therapy to Improve a Poor Result in Childhood Lymphoblastic Leukemia. Cancer Research. 1984 Aug 1;44(8):3593-3598.
Pui, Ching Hon ; Aur, Rhomes J.A. ; Bowman, W. Paul ; Dahl, Gary V. ; Dodge, Richard K. ; George, Stephen L. ; Ochs, Judith ; Kalwinsky, David K. ; Abromowitch, Minnie ; Hustu, H. Omar ; Simone, Joseph V. / Failure of Late Intensification Therapy to Improve a Poor Result in Childhood Lymphoblastic Leukemia. In: Cancer Research. 1984 ; Vol. 44, No. 8. pp. 3593-3598.
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