Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy

G. K. Rivera, C. H. Pui, M. Abromowitch, J. Mirro, J. S. Ochs, A. T. Look, S. B. Murphy, G. V. Dahl, D. K. Kalwinsky, J. V. Simone, W. M. Crist, S. C. Raimondi, F. G. Behm, C. H. Pui, D. L. Williams, M. L. Hancock, W. E. Evans, L. E. Kun

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Abstract

To improve outcome in childhood acute lymphoblastic leukaemia (ALL), a stratified, randomised study of extended intensified chemotherapy was done. 358 evaluable patients received remission reinforcement therapy (teniposide, cytarabine, high-dose methotrexate) added to a four-drug induction regimen. Those achieving complete remission were randomised on the basis of risk group assignment to conventional continuation treatment or to four pairs of drugs rotated weekly or every 6 weeks. All patients received intrathecal chemotherapy; higher-risk patients also received 1800 cGy cranial irradiation after 1 year of remission. Complete remission was induced in 96% of the patients. At median follow-up of 40 (range 19-73) months, 4-year event-free survival (SE) was 73 (4)% overall, 81 (6)% in the lower-risk group (n=110), and 69 (5)% in the higher-risk group (n=248). Outcome within risk groups was not significantly affected by the speed of rotation of drug pairs during continuation treatment. Various highrisk subgroups had apparently improved responses to this treatment. This intensified chemotherapy may cure 69-77% of children with ALL.

Original languageEnglish (US)
Pages (from-to)61-66
Number of pages6
JournalThe Lancet
Volume337
Issue number8733
DOIs
StatePublished - Jan 12 1991

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Combination Drug Therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Drug Therapy
Teniposide
Pharmaceutical Preparations
Cranial Irradiation
Therapeutics
Cytarabine
Methotrexate
Disease-Free Survival

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy. / Rivera, G. K.; Pui, C. H.; Abromowitch, M.; Mirro, J.; Ochs, J. S.; Look, A. T.; Murphy, S. B.; Dahl, G. V.; Kalwinsky, D. K.; Simone, J. V.; Crist, W. M.; Raimondi, S. C.; Behm, F. G.; Pui, C. H.; Williams, D. L.; Hancock, M. L.; Evans, W. E.; Kun, L. E.

In: The Lancet, Vol. 337, No. 8733, 12.01.1991, p. 61-66.

Research output: Contribution to journalArticle

Rivera, GK, Pui, CH, Abromowitch, M, Mirro, J, Ochs, JS, Look, AT, Murphy, SB, Dahl, GV, Kalwinsky, DK, Simone, JV, Crist, WM, Raimondi, SC, Behm, FG, Pui, CH, Williams, DL, Hancock, ML, Evans, WE & Kun, LE 1991, 'Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy', The Lancet, vol. 337, no. 8733, pp. 61-66. https://doi.org/10.1016/0140-6736(91)90733-6
Rivera, G. K. ; Pui, C. H. ; Abromowitch, M. ; Mirro, J. ; Ochs, J. S. ; Look, A. T. ; Murphy, S. B. ; Dahl, G. V. ; Kalwinsky, D. K. ; Simone, J. V. ; Crist, W. M. ; Raimondi, S. C. ; Behm, F. G. ; Pui, C. H. ; Williams, D. L. ; Hancock, M. L. ; Evans, W. E. ; Kun, L. E. / Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy. In: The Lancet. 1991 ; Vol. 337, No. 8733. pp. 61-66.
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AU - Ochs, J. S.

AU - Look, A. T.

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AU - Crist, W. M.

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AU - Behm, F. G.

AU - Pui, C. H.

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AU - Hancock, M. L.

AU - Evans, W. E.

AU - Kun, L. E.

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N2 - To improve outcome in childhood acute lymphoblastic leukaemia (ALL), a stratified, randomised study of extended intensified chemotherapy was done. 358 evaluable patients received remission reinforcement therapy (teniposide, cytarabine, high-dose methotrexate) added to a four-drug induction regimen. Those achieving complete remission were randomised on the basis of risk group assignment to conventional continuation treatment or to four pairs of drugs rotated weekly or every 6 weeks. All patients received intrathecal chemotherapy; higher-risk patients also received 1800 cGy cranial irradiation after 1 year of remission. Complete remission was induced in 96% of the patients. At median follow-up of 40 (range 19-73) months, 4-year event-free survival (SE) was 73 (4)% overall, 81 (6)% in the lower-risk group (n=110), and 69 (5)% in the higher-risk group (n=248). Outcome within risk groups was not significantly affected by the speed of rotation of drug pairs during continuation treatment. Various highrisk subgroups had apparently improved responses to this treatment. This intensified chemotherapy may cure 69-77% of children with ALL.

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