Monthly pulses of vincristine and prednisone prevent bone marrow and testicular relapse in low-risk childhood acute lymphoblastic leukemia: A report of the CCG-161 study by the Childrens Cancer Study Group

W. A. Bleyer, H. N. Sather, H. J. Nickerson, P. F. Coccia, J. Z. Finklestein, D. R. Miller, P. S. Littman, J. N. Lukens, S. E. Siegel, G. D. Hammond

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Abstract

On study CCG-161 of the Childrens Cancer Study Group (CCSG), 631 children with acute lymphoblastic leukemia (ALL) at low risk for relapse were randomized to receive monthly pulses of vincristine-prednisone (VCR-PDN) during maintenance therapy in addition to standard therapy with mercaptopurine (6MP) and methotrexate (MTX), and either cranial irradiation during consolidation or intrathecal (IT) MTX every 3 months during maintenance. All patients received six doses of IT MTX during induction and consolidation. With a minimum follow-up time of 4.25 years, 76.7% receiving VCR-PDN were in continuous complete remission at 5 years, in contrast to 63.9% receiving GMP-MTX alone (P = .002). The difference in relapse-free survival was due primarily to bone marrow relapse (P = .0008), and in boys also to testicular relapse (P = .003). Among the nonirradiated patients, the 5-year disease-free survival (DFS) was 79.4% for patients randomized to the VCR-PDN pulses, in contrast to 61.2% for the patients randomized to receive 6MP-MTX alone (P = .0002). Among the irradiated patients, the DFS was not significantly different. Of the four combinations of maintenance and CNS therapy studied, the highest DFS was achieved with VCR-PDN pulses and maintenance IT MTX.

Original languageEnglish (US)
Pages (from-to)1012-1021
Number of pages10
JournalJournal of Clinical Oncology
Volume9
Issue number6
DOIs
Publication statusPublished - Jan 1 1991

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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