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Liu S, Wang Y. Diagnosis and management of adult central nervous system leukemia. BLOOD SCIENCE 2023; 5:141-149. [PMID: 37546706 PMCID: PMC10400053 DOI: 10.1097/bs9.0000000000000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/09/2023] [Indexed: 08/08/2023] Open
Abstract
Central nervous system leukemia (CNSL) is a prominent infiltration reason for therapy failing in acute leukemia. Recurrence rates and the prognosis have alleviated with current prophylactic regimens. However, the accurate stratification of relapse risk and treatment regimens for relapsed or refractory patients remain clinical challenges yet to be solved. Recently, with hematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor-T (CAR-T) cellular therapy showing encouraging effects in some CNSL patients, advances in treating CNSL have already been reported. The development of molecular targeted agents as well as antibody-based drugs will provide patients with more personalized treatment. This article summarized recent research developments about risk factors, diagnosis, prevention, and treatment in adults with CNSL.
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Affiliation(s)
- Siyu Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Ying Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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de Oliveira Henz P, Pinhatti AV, Gregianin LJ, Martins M, Curra M, de Araújo BV, Dalla Costa T. Population Pharmacokinetic Model of Methotrexate in Brazilian Pediatric Patients with Acute Lymphoblastic Leukemia. Pharm Res 2023; 40:1777-1787. [PMID: 37291462 DOI: 10.1007/s11095-023-03544-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Methotrexate (MTX) is subject to therapeutic drug monitoring because of its high pharmacokinetic variability and safety risk outside the therapeutic window. This study aimed to develop a population pharmacokinetic model (popPK) of MTX for Brazilian pediatric acute lymphoblastic leukemia (ALL) patients who attended the Hospital de Clínicas de Porto Alegre, Brazil. METHODS The model was developed using NONMEM 7.4 (Icon®), ADVAN3 TRANS4, and FOCE-I. To explain inter-individual variability, we evaluated covariates from demographic, biochemical, and genetic data (single nucleotide polymorphisms [SNPs] related to the transport and metabolism of drugs). RESULTS A two-compartment model was built using 483 data points from 45 patients (0.33-17.83 years of age) treated with MTX (0.25-5 g/m2) in different cycles. Serum creatinine (SCR), height (HT), blood urea nitrogen (BUN) and a low BMI stratification (according to the z-score defined by the World Health Organization [LowBMI]) were added as clearance covariates. The final model described MTX clearance as [Formula: see text]. In the two-compartment structural model, the central and peripheral compartment volumes were 26.8 L and 8.47 L, respectively, and the inter-compartmental clearance was 0.218 L/h. External validation of the model was performed through a visual predictive test and metrics using data from 15 other pediatric ALL patients. CONCLUSION The first popPK model of MTX was developed for Brazilian pediatric ALL patients, which showed that inter-individual variability was explained by renal function and factors related to body size.
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Affiliation(s)
- Pricilla de Oliveira Henz
- Pharmacokinetics and PK/PD Modeling Laboratory, Pharmaceutical Sciences Graduate Program, Federal University of Rio Grande do Sul, 2752 Ipiranga Ave., Santana, RS, 90610-000, Porto Alegre, Brazil
| | - Amanda Valle Pinhatti
- Medical Sciences Graduate Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Pediatric Oncology Service, Hospital de Clínicas de Porto Alegre, Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lauro José Gregianin
- Pediatric Oncology Service, Hospital de Clínicas de Porto Alegre, Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Manoela Martins
- Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marina Curra
- Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bibiana Verlindo de Araújo
- Pharmacokinetics and PK/PD Modeling Laboratory, Pharmaceutical Sciences Graduate Program, Federal University of Rio Grande do Sul, 2752 Ipiranga Ave., Santana, RS, 90610-000, Porto Alegre, Brazil
- Medical Sciences Graduate Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Teresa Dalla Costa
- Pharmacokinetics and PK/PD Modeling Laboratory, Pharmaceutical Sciences Graduate Program, Federal University of Rio Grande do Sul, 2752 Ipiranga Ave., Santana, RS, 90610-000, Porto Alegre, Brazil.
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Attarbaschi A, Möricke A, Harrison CJ, Mann G, Baruchel A, De Moerloose B, Conter V, Devidas M, Elitzur S, Escherich G, Hunger SP, Horibe K, Manabe A, Loh ML, Pieters R, Schmiegelow K, Silverman LB, Stary J, Vora A, Pui CH, Schrappe M, Zimmermann M. Outcomes of Childhood Noninfant Acute Lymphoblastic Leukemia With 11q23/ KMT2A Rearrangements in a Modern Therapy Era: A Retrospective International Study. J Clin Oncol 2023; 41:1404-1422. [PMID: 36256911 PMCID: PMC9995095 DOI: 10.1200/jco.22.01297] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/01/2022] [Accepted: 09/07/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We aimed to study prognostic factors and efficacy of allogeneic hematopoietic stem-cell transplantation (allo-HSCT) in first remission of patients with noninfant childhood acute lymphoblastic leukemia (ALL) with 11q23/KMT2A rearrangements treated with chemotherapy regimens between 1995 and 2010. PATIENTS AND METHODS Data were retrospectively retrieved from 629 patients with 11q23/KMT2A-rearranged ALL from 17 members of the Ponte-di-Legno Childhood ALL Working Group. Clinical and biologic characteristics, early response assessed by minimal residual disease at the end of induction (EOI) therapy, and allo-HSCT were analyzed for their impact on outcomes. RESULTS A specific 11q23/KMT2A translocation partner gene was identified in 84.3% of patients, with the most frequent translocations being t(4;11)(q21;q23) (n = 273; 51.5%), t(11;19)(q23;p13.3) (n = 106; 20.0%), t(9;11)(p21_22;q23) (n = 76; 14.3%), t(6;11)(q27;q23) (n = 20; 3.8%), and t(10;11)(p12;q23) (n = 14; 2.6%); 41 patients (7.7%) had less frequently identified translocation partner genes. Patient characteristics and early response varied among subgroups, indicating large biologic heterogeneity and diversity in therapy sensitivity among 11q23/KMT2A-rearranged ALL. The EOI remission rate was 93.2%, and the 5-year event-free survival (EFS) for the entire cohort was 69.1% ± 1.9%, with a range from 41.7% ± 17.3% for patients with t(9;11)-positive T-ALL (n = 9) and 64.8% ± 3.0% for patients with t(4;11)-positive B-ALL (n = 266) to 91.2% ± 4.9% for patients with t(11;19)-positive T-ALL (n = 34). Low EOI minimal residual disease was associated with favorable EFS, and induction failure was particularly predictive of nonresponse to further therapy and relapse and poor EFS. In addition, EFS was not improved by allo-HSCT compared with chemotherapy only in patients with both t(4;11)-positive B-ALL (n = 64 v 51; P = .10) and 11q23/KMT2A-rearranged T-ALL (n = 16 v 10; P = .69). CONCLUSION Compared with historical data, prognosis of patients with noninfant 11q23/KMT2A-rearranged ALL has improved, but allo-HSCT failed to affect outcome. Targeted therapies are needed to reduce relapse and treatment-related mortality rates.
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Affiliation(s)
- Andishe Attarbaschi
- St Anna Children's Hospital and St Anna Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - Anja Möricke
- Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Christine J. Harrison
- Leukaemia Research Cytogenetics Group, Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Georg Mann
- St Anna Children's Hospital and St Anna Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - André Baruchel
- Robert Debré University Hospital (APHP), Université Paris Cité, Paris, France
| | | | - Valentino Conter
- University of Milano-Bicocca, MBBM Foundation/ASST Monza, Monza, Italy
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Sarah Elitzur
- Schneider Children's Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Gabriele Escherich
- Clinic of Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Keizo Horibe
- National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Atsushi Manabe
- Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mignon L. Loh
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Rob Pieters
- Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands
| | - Kjeld Schmiegelow
- Rigshospitalet and University Hospital Copenhagen, Copenhagen, Denmark
- Faculty of Medicine, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Jan Stary
- University Hospital Motol and Charles University, Prague, Czech Republic
| | - Ajay Vora
- Great Ormond Street Hospital, London, United Kingdom
| | - Ching-Hon Pui
- St Jude Children's Research Hospital, Memphis, TN
- University of Tennessee, Memphis, TN
| | - Martin Schrappe
- Christian-Albrechts-University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
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Abu Shanap M, Al Jabour H, Rihani R, Hashem H, Abu Ghosh A, Tbakhi A, Kamal N, Sultan I, Madanat F. Early post-induction augmented therapy improves outcome in children and adolescents with T-cell acute lymphoblastic leukemia. Cancer Rep (Hoboken) 2023; 6:e1703. [PMID: 36806723 PMCID: PMC9940001 DOI: 10.1002/cnr2.1703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION T-cell acute lymphoblastic leukemia (T-ALL) accounts for approximately 15% of all newly diagnosed ALL in children and adolescents and is associated with worse outcomes compared to pre-B ALL. We aimed to decrease T-ALL relapses by intensifying our regimen. METHODS Patients with T-ALL were treated using two different regimens; before September 2014, patients were treated per St. Jude Total XV protocol; subsequently, a major change was adopted by adding two intensive blocks: FLAG and Reintensification. Cranial radiation was limited to patients with WBC ≥ 100 k/μl at diagnosis and/or patients with CNS2/CNS3 status. RESULTS Between June 2005 and April 2020, a total of 100 patients (76 males) were treated and followed up for a median of 70 months (range 14-181). Median age at diagnosis was 9 years (range 0.5-17.8). Forty-eight patients were diagnosed after September 2014 and received the augmented regimen; their median follow up was 46 months (range 14-74). The 5-year-EFS estimates for patients who received the augmented regimen versus standard regimen were 87% ± 4.9% versus 67% ± 6.8% (p = .03); and the 5-year-OS estimates were 87% ± 5.1% versus 71% ± 6.3% (p = .06), respectively. Treatment related mortality (TRM) was reported in two patients treated per standard regimen but none for patients who received the augmented regimen. CONCLUSIONS We implemented a novel approach with early intensification added to a backbone of modified St. Jude Total-XV regimen for patients with T-ALL that resulted in improved outcome with no treatment related mortality.
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Affiliation(s)
| | | | - Rawad Rihani
- Department of PediatricKing Hussein Cancer CenterAmmanJordan
| | - Hasan Hashem
- Department of PediatricKing Hussein Cancer CenterAmmanJordan
| | - Amal Abu Ghosh
- Department of PediatricKing Hussein Cancer CenterAmmanJordan
| | - Abdelghani Tbakhi
- Department of Cell Therapy & Applied GenomicsKing Hussein Cancer CenterAmmanJordan
| | - Nazmi Kamal
- Department of Pathology and Laboratory medicineKing Hussein Cancer CenterAmmanJordan
| | - Iyad Sultan
- Department of PediatricKing Hussein Cancer CenterAmmanJordan
| | - Faris Madanat
- Department of PediatricKing Hussein Cancer CenterAmmanJordan
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Chantziara S, Musoro J, Rowsell AC, Sleurs C, Coens C, Pe M, Suciu S, Kicinski M, Missotten P, Vandecruys E, Uyttebroeck A, Dresse MF, Pluchart C, Ferster A, Freycon C, Bosch JVDWT, Rohrlich P, Benoit Y, Darlington AS, Piette C, Group (CLG TOC(EORTCQOL(QLGAC. Quality of life of long-term childhood acute lymphoblastic leukemia survivors: Comparison with healthy controls. Psychooncology 2022; 31:2159-2168. [PMID: 36307941 PMCID: PMC10099954 DOI: 10.1002/pon.6060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/28/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Improved treatment landscape has led to better outcomes for paediatric acute lymphoblastic leukemia (ALL) survivors. As the number of survivors increase, we need to elucidate the long-term quality of life (QoL) and domains of complaints in these patients. Furthermore, the main priorities of these patients need to be clarified. We assessed long-term QoL outcomes of survivors of childhood ALL compared to matched population controls. METHODS QoL data were collected from survivors recruited in France and Belgium between 2012 and 2017, including the Short Form Health Survey (SF-12) and the Quality of Life Systemic Inventory (QLSI). The Wilcoxon test was used to compare SF-12 scale scores between survivors and matched population controls. For the QLSI, comparisons were mainly descriptive. RESULTS One hundred and eighty-six survivors (mean age: 27.6 years; range: 18.1-52.8) at follow-up completed QoL measures, amongst whom 180 were matched to controls. Overall, survivors had higher QoL on all SF12 scale scores, indicating that they had better functioning compared to controls. Statistically significant differences on the SF12 were observed for Vitality, Social Functioning, Role Limitations due to Emotional Problems and Mental Health scales. QLSI outcomes suggested that survivors were happier than controls with Couple and Social Relations. Controls were unhappiest compared to survivors with Money, Love life, Self-esteem, Nutrition and Paid Work. CONCLUSIONS Our findings suggest that survivors of childhood ALL have better QoL outcomes on some domains compared to the general population, specifically around social and emotional functioning, and that they tend to prioritize their relationships more. Interventions for improving QoL outcomes, might build on existing positive experiences with family, friends and partners.
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Affiliation(s)
- Sofia Chantziara
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jammbe Musoro
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Alison C Rowsell
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Charlotte Sleurs
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Madeline Pe
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Stefan Suciu
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Michal Kicinski
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Pierre Missotten
- Unité de Psychologie de la Sénescence, Université de Liège, Liège, Belgium
| | - Els Vandecruys
- Department of Pediatric Hematology-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Anne Uyttebroeck
- Department of Pediatric Hemato-Oncology, University Hospital Leuven, Leuven, Belgium
| | - Marie-Françoise Dresse
- Division of Haematology-Oncology, Department of Paediatrics, University Hospital Liège and University of Liège, Liège, Belgium
| | - Claire Pluchart
- Department of Pediatric Haematology and Oncology, CHU Reims, Reims, France
| | - Alina Ferster
- Department of Hemato-Oncology, HUDERF (ULB), Brussels, Belgium
| | - Claire Freycon
- Department of Pediatric Hematology-Oncology, CHU Grenoble, Grenoble, France
| | | | | | - Yves Benoit
- Department of Pediatric Hematology-Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Caroline Piette
- Division of Haematology-Oncology, Department of Paediatrics, University Hospital Liège and University of Liège, Liège, Belgium
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Barbati M, Kicinski M, Suciu S, Mazingue F, Vandecruys E, Plat G, Uyttebroeck A, Paillard C, Dresse M, Simon P, Pluchart C, Minckes O, Ferster A, Freycon C, Millot F, Van Der Werff ten Bosch J, Chantrain C, Paulus R, de Schaetzen G, Rossi G, Rohrlich P, Benoit Y, Piette C. Socio-economic outcomes among long-term childhood acute lymphoblastic leukaemia survivors enrolled between 1971 and 1998 in EORTC CLG studies: Results of the 58LAE study. Eur J Cancer Care (Engl) 2022; 31:e13755. [PMID: 36284405 PMCID: PMC9787328 DOI: 10.1111/ecc.13755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/09/2022] [Accepted: 10/09/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the socio-economic outcomes of survivors of childhood acute lymphoblastic leukaemia (ALL). METHODS Childhood ALL adult survivors, enrolled in EORTC trials between 1971 and 1998 in France and Belgium, were invited to fill out a questionnaire with information about their socio-economic situation (living with a partner, having a university degree, having a job, working part time and history of having a paid job). The outcomes were compared with two matched control populations. RESULTS Among 1418 eligible patients, 507 (35.8%) participated, including 39 (8%) and 61 (12%) patients who received a haematopoietic stem cell transplantation (HSCT) and a cranial radiotherapy (CRT), respectively. The median time to follow-up was 20 years, and median age was 25 years. Survivors showed a socio-economic level at least as good as controls. HCST and CRT were associated with a higher probability of not obtaining a bachelor degree (respectively OR = 3.49, 95% CI: 1.46-8.35 and OR = 2.31, 95% CI: 1.04-5.15), HSCT was associated with unemployment (OR = 2.89, 95% CI: 1.09-7.65) and having a relapse was associated with a higher probability of not having a partner (OR = 1.88, 95% CI: 1.01-3.51) adjusting for confounders. CONCLUSION Childhood ALL survivors showed a high level of socio-economic participation. HCST and CRT were associated with poorer functioning.
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Affiliation(s)
- Melissa Barbati
- Department of Pediatric Hematology‐OncologyCHRU LilleLilleFrance
| | | | - Stefan Suciu
- Statistics DepartmentEORTC HeadquartersBrusselsBelgium
| | | | - Els Vandecruys
- Department of Pediatric Hematology‐OncologyGhent University HospitalGhentBelgium
| | | | - Anne Uyttebroeck
- Department of Pediatric Hemato‐OncologyUniversity Hospital LeuvenLeuvenBelgium
| | - Catherine Paillard
- Department of Pediatric Hematology‐OncologyCHRU StrasbourgStrasbourgFrance
| | | | | | - Claire Pluchart
- Department of Pediatric Haematology and OncologyCHU ReimsReimsFrance
| | - Odile Minckes
- Department of Pediatric Hematology‐OncologyCHU CaenCaenFrance
| | - Alina Ferster
- Department of Hemato‐OncologyHUDERF (ULB)BrusselsBelgium
| | - Claire Freycon
- Department of Pediatric Hematology‐OncologyCHU GrenobleGrenobleFrance
| | - Frederic Millot
- Department of Pediatric Hematology‐OncologyCHU PoitiersPoitiersFrance
| | | | | | | | | | - Giovanna Rossi
- Medical DepartmentEORTC HeadquartersBrusselsBelgium,Present address:
R&D DepartmentBreast International Group (BIG)BrusselsBelgium
| | | | - Yves Benoit
- Department of Pediatric Hematology‐OncologyGhent University HospitalGhentBelgium
| | - Caroline Piette
- Department of PaediatricsUniversity Hospital Liège and University of LiègeLiègeBelgium
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Cruz-Chávez DA, López-Pérez BJ, Solórzano-Gómez E, Venta-Sobero JA, Flores-Villegas LV, Toledo-Lozano CG, Castro-Loza GV, Sandoval-Pacheco R, Torres-Vallejo A, Marmol-Realpe KSF, Flores-Jurado YE, Hernández-Soriano CL, Alcaraz-Estrada SL, Mondragón-Terán P, Suárez-Cuenca JA, Coral-Vázquez RM, Garcia S. Neurological Involvement in Pediatric Patients with Acute Leukemia: A Retrospective Cohort. CHILDREN 2022; 9:children9091268. [PMID: 36138577 PMCID: PMC9496928 DOI: 10.3390/children9091268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022]
Abstract
Acute leukemia (AL) is an important cause of morbidity and mortality in children, and neurological manifestations (NM) are frequent. The objective of this study was to analyze neurological manifestations in children with acute leukemia from cases attended in the last five years at the Centro Médico Nacional “20 de Noviembre”. Methods: Conducting a retrospective and analytical study from 1 January 2015 to 31 December 2020 in children with AL classified according to sex, age range and AL type. Participants were grouped according the presence of NM. Results: We analyzed 607 patients: 54.85% boys and 44.14% girls, with a mean age of 7.27 ± 4.54 years. When comparing groups, the NM group was significantly older (p = 0.01), and the highest prevalence was between 6 and 12 years old. ALL was predominant over the other lineages (p ≤ 0.01). The most frequent NM was CNS infiltration, seizures, headache and neuropathy. Death outcomes occurred in 18.7% of children with AML, 11.8% with ALL and 50% with MPAL (p ≤ 0.002). The NM group was associated with higher mortality during a follow-up time of 77.9 ± 49 months (44.4% vs. 8.9% deaths, NM vs. non-NM, respectively; OR = 3.3; 95% CI 2.4 to 4.6; p ≤ 0.0001). Conclusions: ALL was the most prevalent leukemia type. CNS infiltration, seizures, headache, neuropathy and PRES were the most frequent symptoms in the NM group. NM was associated with a higher mortality rate.
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Affiliation(s)
- Diana Alejandra Cruz-Chávez
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Brian Javier López-Pérez
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Elsa Solórzano-Gómez
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - José Antonio Venta-Sobero
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Luz Victoria Flores-Villegas
- Department of Pediatric Hematology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Christian Gabriel Toledo-Lozano
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
- Correspondence: (C.G.T.-L.); (S.G.); Tel.: +52-5519562089 (C.G.T.-L.); +52-5554377491 (S.G.)
| | - Gabriela Vianney Castro-Loza
- Department of Undergraduate Research, Hospital Militar de Especialidades de la Mujer y Neonatología, Mexico City 11200, Mexico
| | - Roberto Sandoval-Pacheco
- Department of Undergraduate Research, Hospital Militar de Especialidades de la Mujer y Neonatología, Mexico City 11200, Mexico
| | - Andrea Torres-Vallejo
- Department of Pediatric Endocrinology, Instituto Nacional de Pediatría, Mexico City 03700, Mexico
| | - Karen Sharlot Faisury Marmol-Realpe
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Yazmín Evelyn Flores-Jurado
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Cristal Lucero Hernández-Soriano
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Sofía Lizeth Alcaraz-Estrada
- Department of Genomic Medicine, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Paul Mondragón-Terán
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Juan Antonio Suárez-Cuenca
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Ramón Mauricio Coral-Vázquez
- Department of Teaching and Research, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
- Postgraduate Section, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Silvia Garcia
- Department of Neuroscience, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
- Correspondence: (C.G.T.-L.); (S.G.); Tel.: +52-5519562089 (C.G.T.-L.); +52-5554377491 (S.G.)
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Lejman M, Chałupnik A, Chilimoniuk Z, Dobosz M. Genetic Biomarkers and Their Clinical Implications in B-Cell Acute Lymphoblastic Leukemia in Children. Int J Mol Sci 2022; 23:ijms23052755. [PMID: 35269896 PMCID: PMC8911213 DOI: 10.3390/ijms23052755] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a heterogeneous group of hematologic malignancies characterized by abnormal proliferation of immature lymphoid cells. It is the most commonly diagnosed childhood cancer with an almost 80% cure rate. Despite favorable survival rates in the pediatric population, a significant number of patients develop resistance to therapy, resulting in poor prognosis. ALL is a heterogeneous disease at the genetic level, but the intensive development of sequencing in the last decade has made it possible to broaden the study of genomic changes. New technologies allow us to detect molecular changes such as point mutations or to characterize epigenetic or proteomic profiles. This process made it possible to identify new subtypes of this disease characterized by constellations of genetic alterations, including chromosome changes, sequence mutations, and DNA copy number alterations. These genetic abnormalities are used as diagnostic, prognostic and predictive biomarkers that play an important role in earlier disease detection, more accurate risk stratification, and treatment. Identification of new ALL biomarkers, and thus a greater understanding of their molecular basis, will lead to better monitoring of the course of the disease. In this article, we provide an overview of the latest information on genomic alterations found in childhood ALL and discuss their impact on patients' clinical outcomes.
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Affiliation(s)
- Monika Lejman
- Laboratory of Genetic Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland
- Correspondence:
| | - Aleksandra Chałupnik
- Student Scientific Society, Laboratory of Genetic Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland; (A.C.); (Z.C.); (M.D.)
| | - Zuzanna Chilimoniuk
- Student Scientific Society, Laboratory of Genetic Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland; (A.C.); (Z.C.); (M.D.)
| | - Maciej Dobosz
- Student Scientific Society, Laboratory of Genetic Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland; (A.C.); (Z.C.); (M.D.)
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9
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Sociodemographic and Medical Determinants of Quality of Life in Long-Term Childhood Acute Lymphoblastic Leukemia Survivors Enrolled in EORTC CLG Studies. Cancers (Basel) 2021; 14:cancers14010152. [PMID: 35008314 PMCID: PMC8750449 DOI: 10.3390/cancers14010152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Long-term quality of life and its potential risk factors in childhood acute lymphoblastic leukemia (ALL) patients remain uncertain. In this cross-sectional study, we investigated daily life quality and life challenges in adult survivors of ALL using multiple self-report questionnaires. Furthermore, risk factors, including gender, age at diagnosis, relapse/second neoplasm, risk group, and cranial radiotherapy, were explored in detail. Younger, female, and relapsed patients appeared to encounter more life challenges, while physical challenges occurred more often in relapsed and high-risk patients. More positive effects on socializing were found in the older patients compared to younger patients. This study provides important information for individual and specialized support. Abstract Background: due to increasing survival rates in childhood acute lymphoblastic leukemia (ALL), the number of survivors has been expanding. A significant proportion of these survivors can experience long-term emotional and psychosocial problems. However, the exact risk factors remain inconclusive. We investigated potential risk factors for decreased daily life quality and life challenges in long-term childhood ALL survivors enrolled between 1971 and 1998 in EORTC studies. Methods: self-report questionnaires were collected from 186 survivors (109 females; mean age at diagnosis 5.62 years, range 0.2–14.7; median time since diagnosis of 20.5 years (12.9–41.6)), including the Short-Form Health Survey (SF-12) and Impact of Cancer-Childhood Survivors (IOC-CS). Multivariable linear regression models were used to assess the impact of gender, age at diagnosis, relapse/second neoplasm, National Cancer Institute (NCI) risk group and cranial radiotherapy on 2 subscales of the SF-12 (physical and mental health) and five subscales of the IOC-CS (life challenges, body and health, personal growth, thinking and memory problems and socializing). Results: mental component scores of SF-12 were not significantly associated with any risk factor. Physical component scores were lower in relapsed, irradiated and NCI high-risk patients. Regarding IOC-CS negative impact subscales, life challenges was more negatively impacted by cancer in female, younger (i.e., <6 years) and relapsed patients. Regarding the positive impact scales, personal growth was more positively impacted in relapsed patients, whereas body and health, and socializing, were less positively impacted in these patients, compared to non-relapsed patients. Socializing was more positively impacted in older patients (>6 years). Conclusions: this study demonstrates that long-term outcomes can be both adverse and positive, depending on the patient’s demographic and clinical characteristics. Younger, female, and relapsed patients might encounter more life challenges years after their disease, while physical challenges could occur more often in relapsed and high-risk patients. Finally, the positive effect on socializing in the older patients sheds new light on the importance of peer interactions for this subgroup. Specific individual challenges thus need specialized support for specific subgroups.
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10
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Optimizing therapy in the modern age: differences in length of maintenance therapy in acute lymphoblastic leukemia. Blood 2021; 137:168-177. [PMID: 32877503 DOI: 10.1182/blood.2020007702] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022] Open
Abstract
A majority of children and young adults with acute lymphoblastic leukemia (ALL) are cured with contemporary multiagent chemotherapy regimens. The high rate of survival is largely the result of 70 years of randomized clinical trials performed by international cooperative groups. Contemporary ALL therapy usually consists of cycles of multiagent chemotherapy administered over 2 to 3 years that includes central nervous system (CNS) prophylaxis, primarily consisting of CNS-penetrating systemic agents and intrathecal therapy. Although the treatment backbones vary among cooperative groups, the same agents are used, and the outcomes are comparable. ALL therapy typically begins with 5 to 9 months of more-intensive chemotherapy followed by a prolonged low-intensity maintenance phase. Historically, a few cooperative groups treated boys with 1 more year of maintenance therapy than girls; however, most groups treated boys and girls with equal therapy lengths. This practice arose because of inferior survival in boys with older less-intensive regimens. The extra year of therapy added significant burden to patients and families and involved short- and long-term risks that were potentially life threatening and debilitating. The Children's Oncology Group recently changed its approach as part of its current generation of trials in B-cell ALL and now treats boys and girls with the same duration of therapy. We discuss the rationale behind this change, review the data and differences in practice across cooperative groups, and provide our perspective regarding the length of maintenance therapy.
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11
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Öztürk AP, Koç B, Zülfikar B. Acute Complications and Survival Analysis of Childhood Acute Lymphoblastic Leukemia: A 15-year Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e39-e47. [PMID: 33046422 DOI: 10.1016/j.clml.2020.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/22/2020] [Accepted: 08/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND We evaluated the acute complications that occurred during the treatment of childhood acute lymphoblastic leukemia (ALL) and documented the survival rates of children with ALL. MATERIALS AND METHODS We retrospectively evaluated 110 children with a diagnosis of ALL treated with the Children's Oncology Group protocol from 1999 to 2014. The demographic, clinical, and laboratory data of 110 patients and acute complications of eligible and evaluable 105 patients were recorded. RESULTS Of the 110 patients, 65 were male and 45 were female. The mean age at admission was 8.3 ± 5.2 years. Ninety-seven patients (88.2%) had been diagnosed with pre-B-cell ALL, 11 (10%) with T-cell ALL, 1 (0.9%) with mixed phenotype acute leukemia, and 1 (0.9%) with mature B-cell acute leukemia. Of the 110 patients, 40 (36.3%) were in the standard-risk group and 70 (63.7%) were in high-risk group. Of the 110 patients, 105 had been followed up regularly and evaluated for acute complications. Infection was the most common complication (n = 93; 88.5%), followed by gastrointestinal (n = 29; 27.6%), neurologic (n = 28; 26.6%), metabolic/endocrine (n = 16; 15.2%), drug-related hypersensitivity (n = 16; 15.2%), avascular necrosis (n = 13; 12.3%), thrombotic (n = 11; 10.4%), severe psychiatric (n = 2; 1.9%), and various other (n = 12; 11.4%) complications. Of the 110 patients, 98 were assessed in terms of survival analysis. The 5- and 10-year overall survival rates were both 85.9% (standard error [SE], 3.6%). The relapse-free survival rates at 1, 3, and 5 years were 97.9% (SE, 1.5%), 91.3% (SE, 3%), and 86.3% (SE, 3.7%), respectively. CONCLUSION Childhood ALL, although categorized as curable malignancy owing to the improvements in treatment strategies in recent years, can cause acute complications affecting various systems. Thus, patients should be treated and followed up by multidisciplinary medical teams with high expertise.
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Affiliation(s)
- Ayşe Pınar Öztürk
- Department of Pediatrics, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
| | - Başak Koç
- Department of Pediatric Hematology-Oncology, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Bülent Zülfikar
- Department of Pediatric Hematology-Oncology, Istanbul University Oncology Institute, Istanbul, Turkey
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12
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Teachey DT, O'Connor D. How I treat newly diagnosed T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma in children. Blood 2020; 135:159-166. [PMID: 31738819 PMCID: PMC6966932 DOI: 10.1182/blood.2019001557] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022] Open
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy that has historically been associated with a very poor prognosis. Nevertheless, despite a lack of incorporation of novel agents, the development of intensified T-ALL-focused protocols has resulted in significant improvements in outcome in children. Through the use of several representative cases, we highlight the key changes that have driven these advances including asparaginase intensification, the use of induction dexamethasone, and the safe omission of cranial radiotherapy. We discuss the results of recent trials to explore key topics including the implementation of risk stratification with minimal residual disease measurement and how to treat high-risk subtypes such as early T-cell precursor ALL. In particular, we address current discrepancies in treatment between different cooperative groups, including the use of nelarabine, and provide rationales for current treatment protocols for both T-ALL and T-lymphoblastic lymphoma.
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Affiliation(s)
- David T Teachey
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David O'Connor
- Department of Haematology, University College London (UCL) Cancer Institute, London, United Kingdom; and
- Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
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13
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Piette C, Suciu S, Bertrand Y, Uyttebroeck A, Vandecruys E, Plat G, Paillard C, Pluchart C, Sirvent N, Maurus R, Poirée M, Simon P, Ferster A, Hoyoux C, Mazingue F, Paulus R, Freycon C, Thomas C, Philippet P, Gilotay C, van der Werff Ten Bosch J, Rohrlich PS, Benoit Y. Long-term outcome evaluation of medium/high risk acute lymphoblastic leukaemia children treated with or without cranial radiotherapy in the EORTC 58832 randomized study. Br J Haematol 2019; 189:351-362. [PMID: 31837008 DOI: 10.1111/bjh.16337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/23/2019] [Indexed: 01/25/2023]
Abstract
We investigated the long-term outcome, the incidence of second neoplasms (SN) and the rate of late adverse effects (LAE) in children with central nervous system (CNS) negative medium/high-risk de novo acute lymphoblastic leukaemia (ALL), in first complete remission (CR1) at end of late intensification, randomized to receive no cranial radiotherapy (No CRT, n = 92) versus CRT (standard arm, n = 84) in the non-inferiority EORTC 58832 study (1983-1989). Median follow-up was 20 years (range 4-32 years). The 25-year disease-free survival rate (±SE) was 67·4 ± 4·9% without CRT and 70·2 ± 5·0% with CRT. The 25-year incidence of isolated (6·5 ± 2·6% vs. 4·8 ± 2·3%) and any CNS relapse {8·7 ± 2·9% vs. 11·9 ± 3·5%; hazard ratio (HR) 0·71 [95% confidence interval (CI) 0·28-1·79]; test of non-inferiority: P = 0·01} was not increased without CRT. The 25-year SN incidence in CR1 was 7·9 ± 4·6% vs. 11·0 ± 4·2%. The 25-year event-free and overall survival rates were quite similar in both arms [59·5 ± 6·3% vs. 60·5 ± 5·9%, HR 0·94 (95% CI 0·57-1·52), and 78·1 ± 4·3% vs. 78·5 ± 4·5%, HR 1·00 (95% CI 0·53-1·88)]. Omission of CRT was associated with dramatic decrease in CNS and endocrine LAE rates. In conclusion, our data suggest that, with proper systemic and intrathecal CNS prophylaxis, CRT could totally be omitted in CR1 without jeopardizing survival, while decreasing LAE in childhood ALL.
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Affiliation(s)
- Caroline Piette
- Division of Haematology-Oncology, Department of Paediatrics, University Hospital Liège and University of Liège, Liège, Belgium
| | | | - Yves Bertrand
- Department of Paediatric Onco-Haematology, Lyon University Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Uyttebroeck
- Department of Paediatric Haematology-Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Els Vandecruys
- Department of Paediatric Haematology-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Geneviève Plat
- Department of Paediatric Onco-Haematology, Purpan University Hospital, Toulouse, France
| | - Catherine Paillard
- Department of Haematology, Hautepierre University Hospital, Strasbourg, France
| | - Claire Pluchart
- Department of Paediatric Onco-Haematology, Reims University Hospital, Reims, France
| | - Nicolas Sirvent
- Department of Paediatric Onco-Haematology, Montpellier University Hospital, Montpellier, France
| | - Renée Maurus
- Department of Paediatric Onco-Haematology, Saint-Pierre Hospital, Brussel, Belgium
| | - Maryline Poirée
- Department of Paediatric Onco-Haematology, Nice University Hospital, Nice, France
| | - Pauline Simon
- Department of Paediatric Onco-Haematology, Besançon University Hospital, Besançon, France
| | - Alina Ferster
- Department of Paediatric Onco-Haematology, Hôpital Universitaire des Enfants Reine Fabiola (ULB), Brussels, Belgium
| | - Claire Hoyoux
- Division of Haematology-Oncology, Department of Paediatrics, University Hospital Liège and University of Liège, Liège, Belgium
| | - Françoise Mazingue
- Department of Paediatric Haematology-Oncology, Lille University Hospital, Lille, France
| | | | - Claire Freycon
- Department of Paediatric Onco-Haematology, Grenoble University Hospital, La Tronche, France
| | - Caroline Thomas
- Department of Paediatric Onco-Haematology, Nantes University Hospital, Nantes, France
| | | | | | | | - Pierre S Rohrlich
- Department of Paediatric Onco-Haematology, Nice University Hospital, Nice, France
| | - Yves Benoit
- Department of Paediatric Haematology-Oncology, Ghent University Hospital, Ghent, Belgium
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14
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Hofmans M, Suciu S, Ferster A, Van Vlierberghe P, Mazingue F, Sirvent N, Costa V, Yakouben K, Paillard C, Uyttebroeck A, Plantaz D, Plat G, Simon P, Millot F, Poirée M, van der Werff ten Bosch J, Piette C, Minckes O, Rohrlich P, Girard S, Cavé H, Bertrand Y, De Moerloose B. Results of successive EORTC‐CLG 58 881 and 58 951 trials in paediatric T‐cell acute lymphoblastic leukaemia (ALL). Br J Haematol 2019; 186:741-753. [DOI: 10.1111/bjh.15983] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/05/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Mattias Hofmans
- Paediatric Haematology‐Oncology and Stem Cell Transplantation Ghent University Hospital GhentBelgium
- Department of Diagnostic Sciences Ghent University GhentBelgium
| | | | - Alina Ferster
- Department of Paediatric Haematology‐Oncology Children's University Hospital Queen FabiolaUniversité Libre de Bruxelles BrusselsBelgium
| | - Pieter Van Vlierberghe
- Cancer Research Institute Ghent GhentBelgium
- Center for Medical Genetics Ghent University Hospital Ghent Belgium
| | - Françoise Mazingue
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Lille LilleFrance
| | - Nicolas Sirvent
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Montpellier MontpellierFrance
- University Montpellier Montpellier France
| | - Vitor Costa
- Paediatric Department Instituto Português de Oncologia Porto Portugal
| | - Karima Yakouben
- Department of Paediatric Haematology Hôpital Robert DebréAP‐HP ParisFrance
| | - Catherine Paillard
- Department of Paediatric Haematology and Oncology Centre Hospitalo‐Universitaire de Strasbourg Strasbourg France
| | - Anne Uyttebroeck
- Department of Paediatric Haematology‐Oncology University Hospital Gasthuisberg Leuven Belgium
| | - Dominique Plantaz
- Department of Paediatric Oncology University Hospital GrenobleFrance
| | - Geneviève Plat
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire, Hopital Purpan ToulouseFrance
| | - Pauline Simon
- Service Hématologie Oncologie Pédiatrique Centre Hospitalier Régional Universitaire de Besançon BesançonFrance
| | | | - Marilyne Poirée
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Nice Nice France
| | | | - Caroline Piette
- Service Universitaire d'Hémato‐Oncologie Pédiatrique Liégeois (SUHOPL)CHR Citadelle Liège Belgium
| | - Odile Minckes
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Caen CaenFrance
| | - Pierre Rohrlich
- Department of Paediatric Haematology‐Oncology Centre Hospitalo‐Universitaire de Nice Nice France
| | - Sandrine Girard
- Laboratory of Haematology Institute of Paediatric Haematology and Oncology (IHOP)Hospices Civils de Lyon LyonFrance
| | - Hélène Cavé
- Département de Génétique Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpital Robert Debré ParisFrance
- INSERM UMR_S1131 Institut de Recherche Saint‐LouisUniversité Paris Diderot ParisFrance
| | - Yves Bertrand
- Institute of Paediatric Haematology and Oncology (IHOP) Haematology UnitHospices Civils de Lyon and Claude Bernard University Lyon France
| | - Barbara De Moerloose
- Paediatric Haematology‐Oncology and Stem Cell Transplantation Ghent University Hospital GhentBelgium
- Cancer Research Institute Ghent GhentBelgium
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Sauter CS, DeFilipp Z, Inamoto Y, Johnston L, Nagler A, Savani BN, Carpenter PA, Perales MA. ASBMT Statement on Routine Prophylaxis for Central Nervous System Recurrence of Acute Lymphoblastic Leukemia following Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:e86-e88. [DOI: 10.1016/j.bbmt.2018.12.757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
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16
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Rhee ES, Kim H, Kang SH, Yoo JW, Koh KN, Im HJ, Seo JJ. Outcome and Prognostic Factors in Pediatric Precursor T-Cell Acute Lymphoblastic Leukemia: A Single-Center Experience. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2018. [DOI: 10.15264/cpho.2018.25.2.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Eun Sang Rhee
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyery Kim
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Han Kang
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Won Yoo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung-Nam Koh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho Joon Im
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Jin Seo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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17
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Piette C, de Rojas T, Suciu S, Kicinski M, Bertrand Y, de Schaetzen G, Gilotay C, Meulemans B, Rossi S, Röhrlich P, Benoit Y. Lessons learnt from the medical and psychosocial evaluation of childhood acute lymphoblastic leukemia (ALL) survivors enrolled in EORTC Children Leukemia Group Trials between 1971 and 1998 and future perspectives for long-term outcome research. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Piette C, Suciu S, Clappier E, Bertrand Y, Drunat S, Girard S, Yakouben K, Plat G, Dastugue N, Mazingue F, Grardel N, van Roy N, Uyttebroeck A, Costa V, Minckes O, Sirvent N, Simon P, Lutz P, Ferster A, Pluchart C, Poirée M, Freycon C, Dresse MF, Millot F, Chantrain C, van der Werff Ten Bosch J, Norga K, Gilotay C, Rohrlich PS, Benoit Y, Cavé H. Differential impact of drugs on the outcome of ETV6-RUNX1 positive childhood B-cell precursor acute lymphoblastic leukaemia: results of the EORTC CLG 58881 and 58951 trials. Leukemia 2018; 32:244-248. [PMID: 29064485 DOI: 10.1038/leu.2017.289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C Piette
- University Department of Pediatrics, Pediatric Onco-Hematology, CHR Citadelle, Liège, Belgium
| | - S Suciu
- EORTC Headquarters, Brussels, Belgium
| | - E Clappier
- Département de Génétique, Hôpital Robert Debré, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Institut Universitaire d'Hématologie, Université Paris Diderot, Paris-Sorbonne-Cité, Paris, France
| | - Y Bertrand
- Department of Pediatric Hematology, IHOP, Hospices Civils de Lyon and Claude Bernard Lyon University, Lyon, France
| | - S Drunat
- Département de Génétique, Hôpital Robert Debré, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - S Girard
- Laboratory of Hematology, East Lyon University Hospital, Hospices Civils de Lyon, Lyon, France
| | - K Yakouben
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Service d'Immuno-Hématologie pédiatrique, Paris, France
| | - G Plat
- Department of Pediatric Onco-Hematology, Purpan University Hospital, Toulouse, France
| | - N Dastugue
- Department of Pediatric Onco-Hematology, Purpan University Hospital, Toulouse, France
| | - F Mazingue
- Department of Pediatric Hematology-Oncology, Lille University Hospital, Lille, France
| | - N Grardel
- Department of Pediatric Hematology-Oncology, Lille University Hospital, Lille, France
| | - N van Roy
- Center for Medical Genetics, Ghent University, Ghent, Belgium
| | - A Uyttebroeck
- Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - V Costa
- Department of Pediatrics, Portuguese Oncology Institute, Porto, Portugal
| | - O Minckes
- Department of Pediatric Onco-Hematology, Caen University Hospital, Caen, France
| | - N Sirvent
- Department of Pediatric Onco-Hematology, Montpellier University Hospital, Montpellier, France
| | - P Simon
- Department of Pediatric Onco-Hematology, Besançon University Hospital, Besançon, France
| | - P Lutz
- Department of Hematology, Hautepierre University Hospital, Strasbourg, France
| | - A Ferster
- Department of Pediatric Onco-Hematology, Hôpital Universitaire des Enfants Reine Fabiola (ULB), Brussels, Belgium
| | - C Pluchart
- Department of Pediatric Onco-Hematology, Reims University Hospital, Reims, France
| | - M Poirée
- Department of Pediatric Onco-Hematology, Nice University Hospital, Nice, France
| | - C Freycon
- Department of Pediatric Onco-Hematology, Grenoble University Hospital, Grenoble, France
| | - M-F Dresse
- University Department of Pediatrics, Pediatric Onco-Hematology, CHR Citadelle, Liège, Belgium
| | - F Millot
- Department of Pediatric Onco-Hematology, Poitiers University Hospital, Poitiers, France
| | - C Chantrain
- Department of Pediatrics, Clinique de l'Espérance, CHC, Liège, Belgium
| | | | - K Norga
- Pediatric Onco-Hematology Unit, Antwerp University Hospital, Antwerp, Belgium
| | - C Gilotay
- EORTC Headquarters, Brussels, Belgium
| | - P-S Rohrlich
- Department of Pediatric Onco-Hematology, Nice University Hospital, Nice, France
| | - Y Benoit
- Department of Pediatric Hematology-Oncology, Ghent University Hospital, Ghent, Belgium
| | - H Cavé
- Département de Génétique, Hôpital Robert Debré, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Institut Universitaire d'Hématologie, Université Paris Diderot, Paris-Sorbonne-Cité, Paris, France
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Schlatter J, Nguyen D, Zamy M, Kabiche S, Fontan JE, Cisternino S. Safety of intrathecal route: focus to methylprednisolone acetate (Depo-Medrol) use. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 28:21-30. [DOI: 10.1007/s00586-017-5387-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/24/2017] [Accepted: 11/05/2017] [Indexed: 11/24/2022]
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Mondelaers V, Suciu S, De Moerloose B, Ferster A, Mazingue F, Plat G, Yakouben K, Uyttebroeck A, Lutz P, Costa V, Sirvent N, Plouvier E, Munzer M, Poirée M, Minckes O, Millot F, Plantaz D, Maes P, Hoyoux C, Cavé H, Rohrlich P, Bertrand Y, Benoit Y. Prolonged versus standard native E. coli asparaginase therapy in childhood acute lymphoblastic leukemia and non-Hodgkin lymphoma: final results of the EORTC-CLG randomized phase III trial 58951. Haematologica 2017; 102:1727-1738. [PMID: 28751566 PMCID: PMC5622857 DOI: 10.3324/haematol.2017.165845] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/21/2017] [Indexed: 12/05/2022] Open
Abstract
Asparaginase is an essential component of combination chemotherapy for childhood acute lymphoblastic leukemia and non-Hodgkin lymphoma. The value of asparaginase was further addressed in a group of non-very high-risk patients by comparing prolonged (long-asparaginase) versus standard (short-asparaginase) native E. coli asparaginase treatment in a randomized part of the phase III 58951 trial of the European Organization for Research and Treatment of Cancer Children’s Leukemia Group. The main endpoint was disease-free survival. Overall, 1,552 patients were randomly assigned to long-asparaginase (775 patients) or short-asparaginase (777 patients). Patients with grade ≥2 allergy to native E. coli asparaginase were switched to equivalent doses of Erwinia or pegylated E. coli asparaginase. The 8-year disease-free survival rate (±standard error) was 87.0±1.3% in the long-asparaginase group and 84.4±1.4% in the short-asparaginase group (hazard ratio: 0.87; P=0.33) and the 8-year overall survival rate was 92.6±1.0% and 91.3±1.2% respectively (hazard ratio: 0.89; P=0.53). An exploratory analysis suggested that the impact of long-asparaginase was beneficial in the National Cancer Institute standard-risk group with regards to disease-free survival (hazard ratio: 0.70; P=0.057), but far less so with regards to overall survival (hazard ratio: 0.89). The incidences of grade 3–4 infection during consolidation (25.2% versus 14.4%) and late intensification (22.6% versus 15.9%) and the incidence of grade 2–4 allergy were higher in the long-asparaginase arm (30% versus 21%). Prolonged native E. coli asparaginase therapy in consolidation and late intensification for our non-very high-risk patients did not improve overall outcome but led to an increase in infections and allergy. This trial was registered at www.clinicaltrials.gov as #NCT00003728.
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Affiliation(s)
- Veerle Mondelaers
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent University, Belgium
| | | | - Barbara De Moerloose
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent University, Belgium
| | - Alina Ferster
- Department of Pediatric Hematology-Oncology, Children's University Hospital Queen Fabiola, Université Libre de Bruxelles (ULB), Belgium
| | | | - Geneviève Plat
- Department of Pediatric Hematology-Oncology, CHU-Hopital Purpan, Toulouse, France
| | - Karima Yakouben
- Department of Pediatric Hematology, Robert Debré Hospital, AP-HP, Paris, France
| | - Anne Uyttebroeck
- Department of Pediatric Hematology-Oncology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Patrick Lutz
- Department of Pediatric Hematology-Oncology, University Hospital Hautepierre, Strasbourg, France
| | - Vitor Costa
- Department of Pediatrics, Portuguese Oncology Institute, Porto, Portugal
| | - Nicolas Sirvent
- Department of Pediatric Hematology-Oncology, CHU, Montpellier, France
| | - Emmanuel Plouvier
- Pediatric Hematology Unit, CHU Jean Minjoz Hospital, Besançon, France
| | - Martine Munzer
- Department of Pediatric Hematology-Oncology, American Memorial Hospital, Reims, France
| | - Maryline Poirée
- Department of Pediatric Hematology-Oncology, CHU Lenval, Nice, France
| | - Odile Minckes
- Department of Pediatric Hematology-Oncology, CHU, Caen, France
| | - Frédéric Millot
- Pediatric Oncology Unit, University Hospital, Poitiers, France
| | - Dominique Plantaz
- Department of Pediatric Oncology, University Hospital, Grenoble, France
| | - Philip Maes
- Department of Pediatrics, University Hospital Antwerp, Belgium
| | - Claire Hoyoux
- Department of Pediatrics, CHR de la Citadelle, Liège, Belgium
| | - Hélène Cavé
- Department of Genetics, Assistance Publique des Hôpitaux de Paris (AP-HP), Robert Debré Hospital, Paris, France.,INSERM UMR 1131, University Institute of Hematology, University Paris Diderot, Paris Sorbonne Cité, France
| | - Pierre Rohrlich
- Department of Pediatric Hematology-Oncology, CHU Lenval, Nice, France
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology (IHOP), Hospices Civils de Lyon, and University Lyon 1, France
| | - Yves Benoit
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent University, Belgium
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21
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Berry DA, Zhou S, Higley H, Mukundan L, Fu S, Reaman GH, Wood BL, Kelloff GJ, Jessup JM, Radich JP. Association of Minimal Residual Disease With Clinical Outcome in Pediatric and Adult Acute Lymphoblastic Leukemia: A Meta-analysis. JAMA Oncol 2017; 3:e170580. [PMID: 28494052 DOI: 10.1001/jamaoncol.2017.0580] [Citation(s) in RCA: 332] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Minimal residual disease (MRD) refers to the presence of disease in cases deemed to be in complete remission by conventional pathologic analysis. Assessing the association of MRD status following induction therapy in patients with acute lymphoblastic leukemia (ALL) with relapse and mortality may improve the efficiency of clinical trials and accelerate drug development. Objective To quantify the relationships between event-free survival (EFS) and overall survival (OS) with MRD status in pediatric and adult ALL using publications of clinical trials and other databases. Data Sources Clinical studies in ALL identified via searches of PubMed, MEDLINE, and clinicaltrials.gov. Study Selection Our search and study screening process adhered to the PRISMA Guidelines. Studies that addressed EFS or OS by MRD status in patients with ALL were included; reviews, abstracts, and studies with fewer than 30 patients or insufficient MRD description were excluded. Data Extraction and Synthesis Study sample size, patient age, follow-up time, timing of MRD assessment (postinduction or consolidation), MRD detection method, phenotype/genotype (B cell, T cell, Philadelphia chromosome), and EFS and OS. Searches of PubMed and MEDLINE identified 566 articles. A parallel search on clinicaltrials.gov found 67 closed trials and 62 open trials as of 2014. Merging results of 2 independent searches and applying exclusions gave 39 publications in 3 arms of patient populations (adult, pediatric, and mixed). We performed separate meta-analyses for each of these 3 subpopulations. Results The 39 publications comprised 13 637 patients: 16 adult studies (2076 patients), 20 pediatric (11 249 patients), and 3 mixed (312 patients). The EFS hazard ratio (HR) for achieving MRD negativity is 0.23 (95% Bayesian credible interval [BCI] 0.18-0.28) for pediatric patients and 0.28 (95% BCI, 0.24-0.33) for adults. The respective HRs in OS are 0.28 (95% BCI, 0.19-0.41) and 0.28 (95% BCI, 0.20-0.39). The effect was similar across all subgroups and covariates. Conclusions and Relevance The value of having achieved MRD negativity is substantial in both pediatric and adult patients with ALL. These results are consistent across therapies, methods of and times of MRD assessment, cutoff levels, and disease subtypes. Minimal residual disease status warrants consideration as an early measure of disease response for evaluating new therapies, improving the efficiency of clinical trials, accelerating drug development, and for regulatory approval. A caveat is that an accelerated approval of a particular new drug using an intermediate end point, such as MRD, would require confirmation using traditional efficacy end points.
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Affiliation(s)
- Donald A Berry
- Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston
| | - Shouhao Zhou
- Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston
| | | | | | - Shuangshuang Fu
- University of Texas Health Science Center at Houston, Houston
| | | | - Brent L Wood
- University of Washington School of Medicine, St Louis, Missouri
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22
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Wolthers BO, Frandsen TL, Abrahamsson J, Albertsen BK, Helt LR, Heyman M, Jónsson ÓG, Kõrgvee LT, Lund B, Raja RA, Rasmussen KK, Taskinen M, Tulstrup M, Vaitkevičienė GE, Yadav R, Gupta R, Schmiegelow K. Asparaginase-associated pancreatitis: a study on phenotype and genotype in the NOPHO ALL2008 protocol. Leukemia 2016; 31:325-332. [PMID: 27451978 DOI: 10.1038/leu.2016.203] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/12/2016] [Accepted: 06/15/2016] [Indexed: 12/17/2022]
Abstract
Asparaginase (ASP)-associated pancreatitis (AAP) occurs during acute lymphoblastic leukemia treatment. Among 1285 children (1.0-17.9 years) diagnosed during July 2008-December 2014 and treated according to the Nordic/Baltic ALL2008 protocol, 86 (cumulative incidence=6.8%) developed AAP. Seventy-three cases were severe (diagnostic AAP criteria persisting >72 h) and 13 mild. Cases were older than controls (median: 6.5 vs 4.5 years; P=0.001). Pseudocysts developed in 28%. Of the 20 re-exposed to ASP, 9 (45%) developed a second AAP. After a median follow-up of 2.3 years, 8% needed permanent insulin therapy, and 7% had recurrent abdominal pain. Germline DNA on 62 cases and 638 controls was genotyped on Omni2.5exome-8-v1.2 BeadChip arrays. Overall, the ULK2 variant rs281366 showed the strongest association with AAP (P=5.8 × 10-7; odds ratio (OR)=6.7). Cases with the rs281366 variant were younger (4.3 vs 8 years; P=0.015) and had lower risk of AAP-related complications (15% vs 43%; P=0.13) compared with cases without this variant. Among 45 cases and 517 controls <10 years, the strongest associations with AAP were found for RGS6 variant rs17179470 (P=9.8 × 10-9; OR=7.3). Rs281366 is located in the ULK2 gene involved in autophagy, and RGS6 regulates G-protein signaling regulating cell dynamics. More than 50% of AAP cases <10 years carried one or both risk alleles.
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Affiliation(s)
- B O Wolthers
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - T L Frandsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - J Abrahamsson
- Department of Clinical Sciences, Queen Silvia's Children's Hospital, Gothenburg, Sweden
| | - B K Albertsen
- Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - L R Helt
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - M Heyman
- Department of Pediatrics, Astrid Lindgrens Hospital, Stockholm, Sweden
| | - Ó G Jónsson
- Children's Hospital, Landspitali University Hospital, Reykjavík, Iceland
| | | | - B Lund
- Department of Paediatrics, St Olavs University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Medical Faculty, The Norwegian University of Science and Technology, Trondheim, Norway
| | - R A Raja
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - K K Rasmussen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - M Taskinen
- Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - M Tulstrup
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - G E Vaitkevičienė
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - R Yadav
- Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark
| | - R Gupta
- Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark
| | - K Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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23
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Sleurs C, Lemiere J, Vercruysse T, Nolf N, Van Calster B, Deprez S, Renard M, Vandecruys E, Benoit Y, Uyttebroeck A. Intellectual development of childhood ALL patients: a multicenter longitudinal study. Psychooncology 2016; 26:508-514. [PMID: 27246629 DOI: 10.1002/pon.4186] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND In childhood acute lymphoblastic leukemia (ALL), radiotherapy for CNS prophylaxis is not used in frontline therapy anymore. Standard treatment for ALL nowadays consists of polychemotherapy. Therefore, assessment of potential chemotherapy-induced cognitive side effects becomes important. Although neurotoxicity was demonstrated in cross-sectional studies, longitudinal studies remain scarce. PROCEDURE We evaluated intellectual development of 94 pediatric ALL patients between 1990 and 1997, diagnosed before the age of 12 years, treated according to the European Organisation for Research and Treatment of Cancer Children's Leukemia Group 58881 protocol. Three assessments of the Wechsler Intelligence Scale for Children Revised were performed since diagnosis, according to age. Using repeated measures regression analysis, we investigated the effect of gender (low versus increased) risk group, parents' education, age at diagnosis, intelligence quotient (IQ) subscale (verbal (VIQ) versus performance (PIQ) intelligence), and test session. RESULTS PIQ scores were lower than VIQ at baseline (-5.3 points on average, p = 0.0032), yet PIQ increased more strongly (PIQ: +3.9 points per test session; VIQ: +0.8, p = 0.0079), so this baseline difference disappeared (p = 0.0079). There were no clear effects of gender (girls: +0.6 points; p = 0.78) or risk group (low risk: +1.5 points; p = 0.49), but IQ scores were higher when one parent had followed higher education (+9.5 points, p < 0.0001). Finally, diagnosis at younger age predicted lower IQ scores (-1.3 points per year, p = 0.0009). CONCLUSION Given that IQ scores did not decline, our findings demonstrate a stable pattern. However, the lower PIQ scores at baseline may indicate that performance functioning is vulnerable to acute neurotoxicity. Also, lower scores for younger patients highlight the stronger impact of the disease and/or treatment at younger age.Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Charlotte Sleurs
- University Hospitals Leuven, Department of Pediatric Hematology and Oncology, Leuven, Belgium.,KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Jurgen Lemiere
- University Hospitals Leuven, Department of Pediatric Hematology and Oncology, Leuven, Belgium
| | - Trui Vercruysse
- University Hospitals Leuven, Department of Pediatric Hematology and Oncology, Leuven, Belgium
| | - Nathalie Nolf
- Ghent University Hospital, Department of Pediatric Hematology and Oncology, Ghent, Belgium
| | - Ben Van Calster
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Sabine Deprez
- University Hospitals Leuven, Department of Radiology, Leuven, Belgium.,KU Leuven, Department of Imaging and Pathology, Leuven, Belgium
| | - Marleen Renard
- University Hospitals Leuven, Department of Pediatric Hematology and Oncology, Leuven, Belgium
| | - Els Vandecruys
- Ghent University Hospital, Department of Pediatric Hematology and Oncology, Ghent, Belgium
| | - Yves Benoit
- Ghent University Hospital, Department of Pediatric Hematology and Oncology, Ghent, Belgium
| | - Anne Uyttebroeck
- University Hospitals Leuven, Department of Pediatric Hematology and Oncology, Leuven, Belgium.,KU Leuven, Department of Development and Regeneration, Leuven, Belgium
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24
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Larsen EC, Devidas M, Chen S, Salzer WL, Raetz EA, Loh ML, Mattano LA, Cole C, Eicher A, Haugan M, Sorenson M, Heerema NA, Carroll AA, Gastier-Foster JM, Borowitz MJ, Wood BL, Willman CL, Winick NJ, Hunger SP, Carroll WL. Dexamethasone and High-Dose Methotrexate Improve Outcome for Children and Young Adults With High-Risk B-Acute Lymphoblastic Leukemia: A Report From Children's Oncology Group Study AALL0232. J Clin Oncol 2016; 34:2380-8. [PMID: 27114587 DOI: 10.1200/jco.2015.62.4544] [Citation(s) in RCA: 263] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Survival for children and young adults with high-risk B-acute lymphoblastic leukemia has improved significantly, but 20% to 25% of patients are not cured. Children's Oncology Group study AALL0232 tested two interventions to improve survival. PATIENTS AND METHODS Between January 2004 and January 2011, AALL0232 enrolled 3,154 participants 1 to 30 years old with newly diagnosed high-risk B-acute lymphoblastic leukemia. By using a 2 × 2 factorial design, 2,914 participants were randomly assigned to receive dexamethasone (14 days) versus prednisone (28 days) during induction and high-dose methotrexate versus Capizzi escalating-dose methotrexate plus pegaspargase during interim maintenance 1. RESULTS Planned interim monitoring showed the superiority of the high-dose methotrexate regimens, which exceeded the predefined boundary and led to cessation of enrollment in January 2011. At that time, participants randomly assigned to high-dose methotrexate during interim maintenance 1 versus those randomly assigned to Capizzi methotrexate had a 5-year event-free survival (EFS) of 82% versus 75.4% (P = .006). Mature final data showed 5-year EFS rates of 79.6% for high-dose methotrexate and 75.2% for Capizzi methotrexate (P = .008). High-dose methotrexate decreased both marrow and CNS recurrences. Patients 1 to 9 years old who received dexamethasone and high-dose methotrexate had a superior outcome compared with those who received the other three regimens (5-year EFS, 91.2% v 83.2%, 80.8%, and 82.1%; P = .015). Older participants derived no benefit from dexamethasone during induction and experienced excess rates of osteonecrosis. CONCLUSION High-dose methotrexate is superior to Capizzi methotrexate for the treatment of high-risk B-acute lymphoblastic leukemia, with no increase in acute toxicity. Dexamethasone given during induction benefited younger children but provided no benefit and was associated with a higher risk of osteonecrosis among participants 10 years and older.
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Affiliation(s)
- Eric C Larsen
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY.
| | - Meenakshi Devidas
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Si Chen
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Wanda L Salzer
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Elizabeth A Raetz
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Mignon L Loh
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Leonard A Mattano
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Catherine Cole
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Alisa Eicher
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Maureen Haugan
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Mark Sorenson
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Nyla A Heerema
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Andrew A Carroll
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Julie M Gastier-Foster
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Michael J Borowitz
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Brent L Wood
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Cheryl L Willman
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Naomi J Winick
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - Stephen P Hunger
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
| | - William L Carroll
- Eric C. Larsen, Maine Children's Cancer Program, Scarborough, ME; Meenakshi Devidas and Si Chen, University of Florida, Gainesville, FL; Wanda L. Salzer, US Army Medical Research and Materiel Command, Frederick; Michael J. Borowitz, Johns Hopkins Medical Institutions, Baltimore, MD; Elizabeth A. Raetz, University of Utah, Salt Lake City, UT, Mignon L. Loh, University of California, San Francisco, San Francisco, CA; Leonard A. Mattano Jr, HARP Pharma Consulting, Mystic, CT; Catherine Cole, Princess Margaret Hospital for Children; University of Western Australia, Perth, Western Australia, Australia; Alisa Eicher, Doernbecher Children's Hospital, Portland, OR; Maureen Haugan, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Mark Sorenson, University of Iowa Hospitals and Clinics, Iowa City, IA; Nyla A. Heerema and Julie M. Gastier-Foster, The Ohio State University School of Medicine, Columbus, OH; Andrew A. Carroll, University of Alabama at Birmingham, Birmingham, AL; Brent L. Wood, University of Washington, Seattle, WA; Cheryl L. Willman, University of New Mexico, Albuquerque, NM; Naomi J. Winick, University of Texas Southwestern Medical Center, Dallas, TX; Stephen P. Hunger, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, PA; and William L. Carroll, New York University Medical Center, New York, NY
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Vora A, Andreano A, Pui CH, Hunger SP, Schrappe M, Moericke A, Biondi A, Escherich G, Silverman LB, Goulden N, Taskinen M, Pieters R, Horibe K, Devidas M, Locatelli F, Valsecchi MG. Influence of Cranial Radiotherapy on Outcome in Children With Acute Lymphoblastic Leukemia Treated With Contemporary Therapy. J Clin Oncol 2016; 34:919-26. [PMID: 26755523 DOI: 10.1200/jco.2015.64.2850] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE We sought to determine whether cranial radiotherapy (CRT) is necessary to prevent relapse in any subgroup of children with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS We obtained aggregate data on relapse and survival outcomes for 16,623 patients age 1 to 18 years old with newly diagnosed ALL treated between 1996 and 2007 by 10 cooperative study groups from around the world. The proportion of patients eligible for prophylactic CRT varied from 0% to 33% by trial and was not related to the proportion eligible for allogeneic stem-cell transplantation in first complete remission. Using a random effects model, with CRT as a dichotomous covariate, we performed a single-arm meta-analysis to compare event-free survival and cumulative incidence of isolated or any CNS relapse and isolated bone marrow relapse in high-risk subgroups of patients who either did or did not receive CRT. RESULTS Although there was significant heterogeneity in all outcome end points according to trial, CRT was associated with a reduced risk of relapse only in the small subgroup of patients with overt CNS disease at diagnosis, who had a significantly lower risk of isolated CNS relapse (4% with CRT v 17% without CRT; P = .02) and a trend toward lower risk of any CNS relapse (7% with CRT v 17% without CRT; P = .09). However, this group had a relatively high rate of events regardless of whether or not they received CRT (32% [95% CI, 26% to 39%] v 34% [95% CI, 19% to 54%]; P = .8). CONCLUSION CRT does not have an impact on the risk of relapse in children with ALL treated on contemporary protocols.
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Affiliation(s)
- Ajay Vora
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
| | - Anita Andreano
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Ching-Hon Pui
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Stephen P Hunger
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Martin Schrappe
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Anja Moericke
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Andrea Biondi
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Gabriele Escherich
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Lewis B Silverman
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Nicholas Goulden
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Mervi Taskinen
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Rob Pieters
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Keizo Horibe
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Meenakshi Devidas
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Franco Locatelli
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Maria Grazia Valsecchi
- Ajay Vora, Sheffield Children's Hospital and University of Sheffield, Sheffield; Nicholas Goulden, Great Ormond Street Hospital, London, United Kingdom; Anita Andreano and Maria Grazia Valsecchi, School of Medicine and Surgery, University of Milano-Bicocca, Milan; Andrea Biondi, University of Milano-Bicocca, Monza; Franco Locatelli, Bambino Gesù Children's Hospital, Rome, and University of Pavia, Pavia, Italy; Ching-Hon Pui, St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN; Stephen P. Hunger, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Lewis B. Silverman, Dana-Faber Cancer Institute and Boston Children's Hospital, Boston, MA; Meenakshi Devidas, Children's Oncology Group Statistics and Data Center and University of Florida, Gainesville, FL; Martin Schrappe and Anja Moericke, University Medical Centre and Christian-Albrechts-University, Kiel; Gabriele Escherich, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Mervi Taskinen, Helsinki University Hospital, Helsinki, Finland; Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht, and Dutch Childhood Oncology Group, the Hague, the Netherlands; and Keizo Horibe, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Brandalise SR, Viana MB, Pinheiro VRP, Mendonça N, Lopes LF, Pereira WV, Lee MLM, Pontes EM, Zouain-Figueiredo GP, Azevedo ACAC, Pimentel N, Fernandes MZ, Oliveira HM, Vianna SR, Scrideli CA, Werneck FA, Álvares MN, Boldrini É, Loggetto SR, Bruniera P, Mastellaro MJ, Souza EM, Araújo RA, Bandeira F, Tan DM, Carvalho NA, Salgado MAS. Shorter Maintenance Therapy in Childhood Acute Lymphoblastic Leukemia: The Experience of the Prospective, Randomized Brazilian GBTLI ALL-93 Protocol. Front Pediatr 2016; 4:110. [PMID: 27800472 PMCID: PMC5066157 DOI: 10.3389/fped.2016.00110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/26/2016] [Indexed: 11/29/2022] Open
Abstract
AIM Maintenance therapy is an important phase of the childhood ALL treatment, requiring 2-year long therapy adherence of the patients and families. Weekly methotrexate with daily 6-mercaptopurine (6MP) constitutes the backbone of maintenance therapy. Reduction in the maintenance therapy could overweight problems related with poverty of children with ALL living in limited-income countries (LIC). OBJECTIVE To compare, prospectively, the EFS rates of children with ALL treated according to two maintenance regimens: 18 vs. 24 months duration. MATERIALS AND METHODS From October 1993 to September 1999, 867 consecutive untreated ALL patients <18 years of age were treated according to the Brazilian Cooperative Group for Childhood ALL Treatment (GBTLI) ALL-93 protocol. Risk classification was based exclusively on patient's age and leukocyte count (NCI risk group) and clinical extra medullary involvement of the disease. Data were analyzed by the intention-to-treat approach. RESULTS Fourteen patients (1.6%) were excluded: wrong diagnosis (n = 7) and previous corticosteroid (n = 7). Of the 853 eligible patients, 421 were randomly allocated, at study enrollment, to receive 18-month (group 1) and 432 to receive 24-month (group 2) maintenance therapy. Complete remission rate was achieved in 96% of the patients (817/853). Twenty-eight patients (3.4%) died during the induction phase. Thirty-four patients (4.0%) were lost to follow-up. The overall EFS was 66.1 ± 1.7% at 15 years. No difference was seen according to maintenance: EFS15y was 65.8 ± 2.3% (group 1) and 66.3 ± 2.3% (group 2; p = 0.79). No difference between regimens was detected after stratifying the analyses according to factors associated with adverse prognosis in this study (age group <1 year or >10 years and high WBC at diagnosis). Overall death in remission rate was 6.85% (56 patients). Deaths during maintenance were 13 in group 1 and 12 in group 2, all due to infection. Over 15 years of follow-up, two patients both from group 2 presented a second malignancy (Hodgkin's disease and thyroid carcinoma) after 8.3 and 11 years off therapy, respectively. CONCLUSION Six-month reduction of maintenance therapy in ALL children treated according to the GBTLI ALL-93 protocol provided the same overall outcome as 2-year duration regimen.
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Affiliation(s)
| | - Marcos B Viana
- Federal University of Minas Gerais , Belo Horizonte , Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Flávia Bandeira
- Hematology and Hemotherapy Foundation (HEMOPE) , Recife , Brazil
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27
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Wilejto M, Di Giuseppe G, Hitzler J, Gupta S, Abla O. Treatment of young children with CNS-positive acute lymphoblastic leukemia without cranial radiotherapy. Pediatr Blood Cancer 2015; 62:1881-5. [PMID: 26154757 DOI: 10.1002/pbc.25620] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 04/21/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Due to the long-term sequelae of cranial radiotherapy (CRT), contemporary treatment protocols for children with acute lymphoblastic leukemia (ALL) aim to limit the use of prophylactic CRT. For patients with central nervous system (CNS) involvement with ALL at diagnosis, the use of CRT remains common. Children <5 years of age are a particularly challenging subgroup in whom the consequences of CRT can be devastating. PROCEDURE This study retrospectively describes the overall (OS) and event-free survival (EFS) of young children (1-5 years) who were treated for CNS-positive ALL at the Hospital for Sick Children between 2000 and 2013. RESULTS Of a total of 19 patients, two were treated with upfront CRT, both as part of the conditioning regimen prior to HSCT. All patients received intensification of CNS-directed chemotherapy by triple intra-thecal chemotherapy (84.2%), use of dexamethasone in induction (57.9%) and maintenance (66.7%), and high-dose methotrexate (77.8%). The OS was 84.2 ± 8.4% and EFS was 79.0 ± 9.4% with a median follow-up time of 4.3 years (range, 2.6-8.2). The cumulative incidence of CNS relapse was 5.2 ± 5.1%. CONCLUSIONS We conclude that omission of CRT from the treatment of young children with ALL involving the CNS is associated with acceptable survival and avoids potentially devastating late effects in this group.
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Affiliation(s)
- Marta Wilejto
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Giancarlo Di Giuseppe
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Johann Hitzler
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Oussama Abla
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
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Fukano R, Nishimura M, Ito N, Nakashima K, Kodama Y, Okamura J, Inagaki J. Efficacy of prophylactic additional cranial irradiation and intrathecal chemotherapy for the prevention of CNS relapse after allogeneic hematopoietic SCT for childhood ALL. Pediatr Transplant 2014; 18:518-23. [PMID: 24815062 DOI: 10.1111/petr.12276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 11/30/2022]
Abstract
We evaluated the efficacy of CRT and IT chemotherapy, in addition to conditioning including TBI, for the prevention of CNS relapse, in allogeneic HSCT for childhood ALL. From January 1999 to December 2009, a total of 48 patients, without previous or presenting CNS involvement, underwent HSCT for ALL. All patients received myeloablative conditioning including TBI of 12 or 13.2 Gy and IT chemotherapy twice between days -10 and -2 prior to HSCT. Twenty-five patients received CRT prior to TBI (CRT+), and 23 patients did not (CRT-). CRT+ and CRT- patients had a seven-yr EFS rate of 40.0 ± 9.8% and 41.7 ± 10.6%, respectively (p = 0.8252). The seven-yr relapse rates for CRT+ and CRT- patients were 45.0 ± 11.2% and 38.4 ± 11.6%, respectively (p = 0.7460). CNS relapses were evident in 1 (4.0%) CRT+ patient and 1 (4.4%) CRT- patient (p = 1.000). There were no significant differences in EFS and the probability of CNS relapse between CRT+ and CRT- patients. These results demonstrate that CRT and IT chemotherapy, in addition to conditioning chemotherapy, may not be necessary in childhood ALL patients without previous or presenting CNS involvement.
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Affiliation(s)
- Reiji Fukano
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
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Domenech C, Suciu S, De Moerloose B, Mazingue F, Plat G, Ferster A, Uyttebroeck A, Sirvent N, Lutz P, Yakouben K, Munzer M, Röhrlich P, Plantaz D, Millot F, Philippet P, Dastugue N, Girard S, Cavé H, Benoit Y, Bertrandfor Y. Dexamethasone (6 mg/m2/day) and prednisolone (60 mg/m2/day) were equally effective as induction therapy for childhood acute lymphoblastic leukemia in the EORTC CLG 58951 randomized trial. Haematologica 2014; 99:1220-7. [PMID: 24727815 PMCID: PMC4077084 DOI: 10.3324/haematol.2014.103507] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 04/04/2014] [Indexed: 02/05/2023] Open
Abstract
Dexamethasone could be more effective than prednisolone at similar anti-inflammatory doses in the treatment of childhood acute lymphoblastic leukemia. In order to check if this "superiority" of dexamethasone might be dose-dependent, we conducted a randomized phase III trial comparing dexamethasone (6 mg/m(2)/day) to prednisolone (60 mg/m(2)/day) in induction therapy. All newly diagnosed children and adolescents with acute lymphoblastic leukemia in the 58951 EORTC trial were randomized on prephase day 1 or day 8. The main endpoint was event-free survival; secondary endpoints were overall survival and toxicity. A total of 1947 patients with acute lymphoblastic leukemia were randomized. At a median follow-up of 6.9 years, the 8-year event-free survival rate was 81.5% in the dexamethasone arm and 81.2% in the prednisolone arm; the 8-year overall survival rates were 87.2% and 89.0% respectively. The 8-year incidences of isolated or combined central nervous system relapse were 2.9% and 4.5% in the dexamethasone and prednisolone arms, respectively. The incidence of grade 3-4 toxicities during induction and the frequency of osteonecrosis were similar in the two arms. In conclusion, dexamethasone and prednisolone, used respectively at the doses of 6 and 60 mg/m(2)/day during induction, were equally effective and had a similar toxicity profile. Dexamethasone decreased the 8-year central nervous system relapse incidence by 1.6%. This trial was registered at www.clinicaltrials.gov as #NCT00003728.
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Affiliation(s)
- Carine Domenech
- Institute of Hematology and Oncology Pediatrics, Hospices Civils de Lyon, University Claude Bernard Lyon I, France
| | | | | | | | - Geneviève Plat
- Department of Hematology, Children's Hospital, Toulouse, France
| | - Alina Ferster
- Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Nicolas Sirvent
- Department of Hemato-Oncology, A Villeneuve Hospital, Montpellier, France
| | - Patrick Lutz
- Department of Hematology, Hautepierre, Strasbourg, France
| | - Karima Yakouben
- Department of Hematology, Robert Debré Hospital, Paris, France
| | - Martine Munzer
- Department of Hematology, American Hospital, Reims, France
| | | | | | - Frederic Millot
- Department of Hematology, J Bernard Hospital, Poitiers, France
| | | | - Nicole Dastugue
- Department of Hematology, Children's Hospital, Toulouse, France
| | - Sandrine Girard
- Department of Hematology, Edouard Herriot Hospital, Hospices Civils de Lyon, France
| | - Hélène Cavé
- Department of Genetics, Robert-Debré Hospital, Paris, France
| | - Yves Benoit
- Department of Pediatric Hematology-Oncology, Ghent University Hospital, Belgium
| | - Yves Bertrandfor
- Institute of Hematology and Oncology Pediatrics, Hospices Civils de Lyon, University Claude Bernard Lyon I, France
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Liu HC, Yeh TC, Hou JY, Chen KH, Huang TH, Chang CY, Liang DC. Triple Intrathecal Therapy Alone With Omission of Cranial Radiation in Children With Acute Lymphoblastic Leukemia. J Clin Oncol 2014; 32:1825-9. [DOI: 10.1200/jco.2013.54.5020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To eliminate the toxicities and sequelae of cranial irradiation (CrRT) and to minimize the adverse impact of traumatic lumbar puncture (TLP) with blasts, a prospective study of a modified CNS-directed therapy was conducted in children with acute lymphoblastic leukemia (ALL). Patients and Methods Since June 1999, children with newly diagnosed ALL have been treated with triple intrathecal therapy (TIT) alone without CrRT. The first TIT was delayed until the disappearance of blasts from peripheral blood (PB) for up to 10 days of multidrug induction, and CrRT was omitted in all patients. If PB blasts persisted on treatment day 10 (d10), the TIT was then performed. Results Of a total of 156 patients, 152 were eligible. Seventeen patients did not have PB blasts at diagnosis. Three fourths of the remaining patients achieved complete clearance of PB blasts by d10. Only hyperleukocytosis at diagnosis showed a significantly lower clearance rate. Six standard-risk patients were upgraded to high risk because of detectable PB blasts on d10. TLPs were encountered in four patients (2.6%), but none were contaminated with lymphoblasts. Neither CNS-2 (less than 5 WBCs/μL with blasts in a nontraumatic sample) nor CNS-3 (≥ 5 WBCs/μL with blasts in a nontraumatic sample or the presence of cranial nerve palsy) was present. The 5-year event-free survival and overall survival rates ± SE were 84.2% ± 3.0% and 90.6% ± 2.4%, respectively. No isolated CNS relapse occurred, but two patients experienced combined CNS relapses. The 7-year cumulative risk of any CNS relapse was 1.4% ± 1.0%. Conclusion Delaying first TIT until circulating blasts have cleared may improve CNS control in children with newly diagnosed ALL and preclude the need for CrRT.
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Affiliation(s)
- Hsi-Che Liu
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ting-Chi Yeh
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Jen-Yin Hou
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kuan-Hao Chen
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ting-Huan Huang
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ching-Yi Chang
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
| | - Der-Cherng Liang
- Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, and Der-Cherng Liang, Mackay Medical College, New Taipei; and Hsi-Che Liu, Ting-Chi Yeh, Jen-Yin Hou, Kuan-Hao Chen, Ting-Huan Huang, Ching-Yi Chang, and Der-Cherng Liang, Mackay Memorial Hospital, Taipei, Taiwan
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31
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Koka A, Saygin C, Uzunaslan D, Ozdemir N, Apak H, Celkan T. A 17-year experience with ALL-BFM protocol in acute lymphoblastic leukemia: Prognostic predictors and interruptions during protocol. Leuk Res 2014; 38:699-705. [DOI: 10.1016/j.leukres.2014.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 02/26/2014] [Accepted: 03/18/2014] [Indexed: 12/31/2022]
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32
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Kotecha RS, Gottardo NG, Kees UR, Cole CH. The evolution of clinical trials for infant acute lymphoblastic leukemia. Blood Cancer J 2014; 4:e200. [PMID: 24727996 PMCID: PMC4003413 DOI: 10.1038/bcj.2014.17] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 02/07/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) in infants has a significantly inferior outcome in comparison with older children. Despite initial improvements in survival of infants with ALL since establishment of the first pediatric cooperative group ALL trials, the poor outcome has plateaued in recent years. Historically, infants were treated on risk-adapted childhood ALL protocols. These studies were pivotal in identifying the need for infant-specific protocols, delineating prognostic categories and the requirement for a more unified approach between study groups to overcome limitations in accrual because of low incidence. This subsequently led to the development of collaborative infant-specific studies. Landmark outcomes have included the elimination of cranial radiotherapy following the discovery of intrathecal and high-dose systemic therapy as a superior and effective treatment strategy for central nervous system disease prophylaxis, with improved neurodevelopmental outcome. Universal prospective identification of independent adverse prognostic factors, including presence of a mixed lineage leukemia rearrangement and young age, has established the basis for risk stratification within current trials. The infant-specific trials have defined limits to which conventional chemotherapeutic agents can be intensified to optimize the balance between treatment efficacy and toxicity. Despite variations in therapeutic intensity, there has been no recent improvement in survival due to the equilibrium between relapse and toxicity. Ultimately, to improve the outcome for infants with ALL, key areas still to be addressed include identification and adaptation of novel prognostic markers and innovative therapies, establishing the role of hematopoietic stem cell transplantation in first complete remission, treatment strategies for relapsed/refractory disease and monitoring and timely intervention of late effects in survivors. This would be best achieved through a single unified international trial.
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Affiliation(s)
- R S Kotecha
- 1] Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia [2] Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia [3] School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - N G Gottardo
- 1] Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia [2] Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia [3] School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - U R Kees
- Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - C H Cole
- 1] Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia [2] Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia [3] School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
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Stary J, Zimmermann M, Campbell M, Castillo L, Dibar E, Donska S, Gonzalez A, Izraeli S, Janic D, Jazbec J, Konja J, Kaiserova E, Kowalczyk J, Kovacs G, Li CK, Magyarosy E, Popa A, Stark B, Jabali Y, Trka J, Hrusak O, Riehm H, Masera G, Schrappe M. Intensive chemotherapy for childhood acute lymphoblastic leukemia: results of the randomized intercontinental trial ALL IC-BFM 2002. J Clin Oncol 2013; 32:174-84. [PMID: 24344215 DOI: 10.1200/jco.2013.48.6522] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE From 2002 to 2007, the International Berlin-Frankfurt-Münster Study Group conducted a prospective randomized clinical trial (ALL IC-BFM 2002) for the management of childhood acute lymphoblastic leukemia (ALL) in 15 countries on three continents. The aim of this trial was to explore the impact of differential delayed intensification (DI) on outcome in all risk groups. PATIENTS AND METHODS For this trial, 5,060 eligible patients were divided into three risk groups according to age, WBC, early treatment response, and unfavorable genetic aberrations. DI was randomized as follows: standard risk (SR), two 4-week intensive elements (protocol III) versus one 7-week protocol II; intermediate risk (IR), protocol III × 3 versus protocol II × 1; high risk (HR), protocol III × 3 versus either protocol II × 2 (Associazione Italiana Ematologia Oncologia Pediatrica [AIEOP] option), or 3 HR blocks plus single protocol II (Berlin-Frankfurt-Münster [BFM] option). RESULTS At 5 years, the probabilities of event-free survival and survival were 74% (± 1%) and 82% (± 1%) for all 5,060 eligible patients, 81% and 90% for the SR (n = 1,564), 75% and 83% for the IR (n = 2,650), and 55% and 62% for the HR (n = 846) groups, respectively. No improvement was accomplished by more intense and/or prolonged DI. CONCLUSION The ALL IC-BFM 2002 trial is a good example of international collaboration in pediatric oncology. A wide platform of countries able to run randomized studies in ALL has been established. Although the alternative DI did not improve outcome compared with standard treatment and the overall results are worse than those achieved by longer established leukemia groups, the national results have generally improved.
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Affiliation(s)
- Jan Stary
- Jan Stary, Jan Trka, and Ondrej Hrusak, Charles University and University Hospital Motol, Prague; Yahia Jabali, Regional Hospital, Ceske Budejovice, Czech Republic; Martin Zimmermann and Hansjörg Riehm, Medical School Hannover, Hannover; Martin Schrappe, University Hospital Schleswig-Holstein, Kiel, Germany; Myriam Campbell, Roberto del Rio Hospital, Universidad de Chile, Santiago, Chile; Luis Castillo, Hospital Pereira Rossell, Montevideo, Uruguay; Eduardo Dibar, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Svetlana Donska, Regional Oncologic Hospital, Kiev, Ukraine; Alejandro Gonzalez, Institute of Hematology and Immunology, La Habana, Cuba; Shai Izraeli, Sheba Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Tel Hashomer; Batia Stark, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Petah-Tikva, Israel; Dragana Janic, University Children's Hospital, University of Belgrade, Belgrade, Serbia; Janez Jazbec, University Children's Hospital, Ljubljana, Slovenia; Josip Konja, University Hospital Centre Rebro, Zagreb, Croatia; Emilia Kaiserova, University Children's Hospital, Bratislava, Slovakia; Jerzy Kowalczyk, University of Lublin, Lublin, Poland; Gabor Kovacs and Edina Magyarosy, Semmelweis University, Budapest, Hungary; Chi-Kong Li, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Alexander Popa, N.N. Blokhin Russian Cancer Research Center, Moscow, Russia; and Giuseppe Masera, Ospedale S. Gerardo, University of Milano-Bicocca, Monza, Italy
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Ko SY, Chi HS, Jang S, Park CJ. Morphologic detection of blast cells in the cerebrospinal fluid at diagnosis of adult acute lymphoblastic leukemia appears to be associated with adverse prognosis. Int J Lab Hematol 2013; 36:451-8. [PMID: 24262072 DOI: 10.1111/ijlh.12166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/07/2013] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Appropriate treatment of central nervous system (CNS) involvement in adult acute lymphoblastic leukemia (ALL) is important for patient prognosis, but the diagnostic criteria of CNS involvement has not been established. METHODS The significance of blast cells in the cerebrospinal fluid (CSF) at diagnosis was evaluated in 81 adults newly diagnosed with ALL. Patients with unequivocal morphologic evidence of lymphoblasts in the cytocentrifuged CSF slide were considered to have CNS involvement regardless of the leukocyte count. The outcomes of the patients were analyzed. RESULTS Four of the 81 patients (5%) had detectable blast cells, and three of these four patients had less than five leukocytes/μL of CSF. One-year event-free survival (EFS) was 25.0% and 53.2% (P = 0.008) and overall survival (OS) was 50.0% and 68.8% (P = 0.001) in patients with and without CNS involvement, respectively. CNS involvement had prognostic impact on EFS (P = 0.047) and OS (P = 0.009) after adjusting for sex, age, leukocyte count, Philadelphia chromosome status, and immunophenotype. CONCLUSION This study suggests that morphologic detection of blast cells in the CSF at diagnosis of adult ALL, regardless of the leukocyte count, is associated with adverse prognosis.
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Affiliation(s)
- S-Y Ko
- Department of Laboratory Medicine, College of Medicine, Korea University, Seongbuk-gu, Seoul, South Korea
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Acute lymphoblastic leukemia in children with Down syndrome: a retrospective analysis from the Ponte di Legno study group. Blood 2013; 123:70-7. [PMID: 24222333 DOI: 10.1182/blood-2013-06-509463] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Children with Down syndrome (DS) have an increased risk of B-cell precursor (BCP) acute lymphoblastic leukemia (ALL). The prognostic factors and outcome of DS-ALL patients treated in contemporary protocols are uncertain. We studied 653 DS-ALL patients enrolled in 16 international trials from 1995 to 2004. Non-DS BCP-ALL patients from the Dutch Child Oncology Group and Berlin-Frankfurt-Münster were reference cohorts. DS-ALL patients had a higher 8-year cumulative incidence of relapse (26% ± 2% vs 15% ± 1%, P < .001) and 2-year treatment-related mortality (TRM) (7% ± 1% vs 2.0% ± <1%, P < .0001) than non-DS patients, resulting in lower 8-year event-free survival (EFS) (64% ± 2% vs 81% ± 2%, P < .0001) and overall survival (74% ± 2% vs 89% ± 1%, P < .0001). Independent favorable prognostic factors include age <6 years (hazard ratio [HR] = 0.58, P = .002), white blood cell (WBC) count <10 × 10(9)/L (HR = 0.60, P = .005), and ETV6-RUNX1 (HR = 0.14, P = .006) for EFS and age (HR = 0.48, P < .001), ETV6-RUNX1 (HR = 0.1, P = .016) and high hyperdiploidy (HeH) (HR = 0.29, P = .04) for relapse-free survival. TRM was the major cause of death in ETV6-RUNX1 and HeH DS-ALLs. Thus, while relapse is the main contributor to poorer survival in DS-ALL, infection-associated TRM was increased in all protocol elements, unrelated to treatment phase or regimen. Future strategies to improve outcome in DS-ALL should include improved supportive care throughout therapy and reduction of therapy in newly identified good-prognosis subgroups.
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Abstract
Lymphoblastic lymphoma (LBL) are thought to derive from immature precursor T-cells or B-cells. LBL are the second most common subtype of Non-Hodgkin Lymphoma (NHL) in children and adolescents. LBL are closely related to acute lymphoblastic leukemia (ALL), the most common type of cancer in children. Using ALL-type treatment regimen to treat children with LBL was an important development in the treatment of LBL. During the last decades, several systematic clinical trials contributed to the controlled optimization of treatment. Today event-free survival (EFS) can be achieved for 75-90% of patients. However, acute and long-term toxicity, the lack of prognostic parameters and the poor outcome for patients who suffer from refractory or relapsed LBL remain highly relevant subjects for improvement. To date, the pathogenesis of LBL is poorly understood. Learning more about the biology and pathogenesis of LBL might pave the way for targeted treatment to improve survival especially in relapsed and refractory patients.
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Affiliation(s)
- Eva Schmidt
- Department of Hematology and Oncology, University Hospital Muenster, Germany
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Schuitema I, Deprez S, Van Hecke W, Daams M, Uyttebroeck A, Sunaert S, Barkhof F, van Dulmen-den Broeder E, van der Pal HJ, van den Bos C, Veerman AJP, de Sonneville LMJ. Accelerated aging, decreased white matter integrity, and associated neuropsychological dysfunction 25 years after pediatric lymphoid malignancies. J Clin Oncol 2013; 31:3378-88. [PMID: 23960182 DOI: 10.1200/jco.2012.46.7050] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE CNS-directed chemotherapy (CT) and cranial radiotherapy (CRT) for childhood acute lymphoblastic leukemia or lymphoma have various neurotoxic properties. This study aimed to assess their impact on the maturing brain 20 to 30 years after diagnosis, providing a much stronger perspective on long-term quality of life than previous studies. PATIENTS AND METHODS Ninety-three patients treated between 1978 and 1990 at various intensities, with and without CRT, and 49 healthy controls were assessed with magnetic resonance diffusion tensor imaging (DTI) and neuropsychological tests. Differences in fractional anisotropy (FA)-a DTI measure describing white matter (WM) microstructure-were analyzed by using whole brain voxel-based analysis. RESULTS CRT-treated survivors demonstrated significantly decreased FA compared with controls in frontal, parietal, and temporal WM tracts. Trends for lower FA were seen in the CT-treated survivors. Decreases in FA correlated well with neuropsychological dysfunction. In contrast to the CT group and controls, the CRT group showed a steep decline of FA with age at assessment. Younger age at cranial irradiation and higher dosage were associated with worse outcome of WM integrity. CONCLUSION CRT-treated survivors show decreased WM integrity reflected by significantly decreased FA and associated neuropsychological dysfunction 25 years after treatment, although effects of CT alone seem mild. Accelerated aging of the brain and increased risk of early onset dementia are suspected after CRT, but not after CT.
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Affiliation(s)
- Ilse Schuitema
- Ilse Schuitema and Leo M.J. de Sonneville, Leiden University, Leiden; Ilse Schuitema, Marita Daams, Frederik Barkhof, Eline van Dulmen-den Broeder, and Anjo J.P. Veerman, Vrije Universiteit University Medical Center; Helena J. van der Pal and Cor van den Bos, Academic Medical Center, Amsterdam, the Netherlands; Sabine Deprez, Anne Uyttebroeck, and Stefan Sunaert, University Hospitals Leuven; Wim Van Hecke, icoMetrix, Leuven, Belgium
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Vandecruys E, Dhooge C, Craen M, Benoit Y, De Schepper J. Longitudinal linear growth and final height is impaired in childhood acute lymphoblastic leukemia survivors after treatment without cranial irradiation. J Pediatr 2013; 163:268-73. [PMID: 23351599 DOI: 10.1016/j.jpeds.2012.12.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/22/2012] [Accepted: 12/12/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate long-term growth and final height (FH) in survivors of childhood acute lymphoblastic leukemia (ALL) who were treated without cranial radiation therapy and underwent evaluation of growth hormone (GH) status at the end of treatment. STUDY DESIGN Data on longitudinal growth (collected at the start of treatment, end of treatment, and 1 year thereafter) and FH of 67 adult survivors of childhood ALL who had been treated according to European Organisation for Research and Treatment of Cancer 58831/2 protocols with chemotherapy as the only treatment modality were reviewed retrospectively. Height data were expressed as SDS for national references. The relative role of sex, age at diagnosis, intensity of chemotherapeutic regimen, and GH status at the end of treatment as contributing factors were analyzed. RESULTS A modest but significant loss in FH (change in SDS [ΔSDS] = -0.59 ± 0.86; P < .001) was found. Two-thirds of the height deficit observed from diagnosis until FH occurred during treatment. The height deficit was more severe in the male patients (P = .036). The ΔSDS for height from diagnosis to FH was not correlated with age at diagnosis or intensity of treatment. No correlation was found between the results of the GH stimulation test and ΔSDS for height from diagnosis or the end of treatment to FH. CONCLUSION Adult survivors of childhood ALL treated with chemotherapeutic regimens of moderate intensity without cranial radiation therapy exhibit a modest loss in SDS for height at FH irrespective of GH status at the cessation of treatment.
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Affiliation(s)
- Els Vandecruys
- Department of Pediatric Hemato-Oncology, Ghent University Hospital, Ghent, Belgium.
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Girard P, Auquier P, Barlogis V, Contet A, Poiree M, Demeocq F, Berbis J, Herrmann I, Villes V, Sirvent N, Kanold J, Chastagner P, Chambost H, Plantaz D, Michel G. Symptomatic osteonecrosis in childhood leukemia survivors: prevalence, risk factors and impact on quality of life in adulthood. Haematologica 2013; 98:1089-97. [PMID: 23645686 DOI: 10.3324/haematol.2012.081265] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Corticosteroid can induce osteonecrosis in children with leukemia. Few studies have been designed to assess the influence of a wide range of cumulative steroid dose on this side effect. Prevalence, risk factors of symptomatic osteonecrosis and its impact on adults' Quality of Life were assessed in 943 patients enrolled in the French "Leucémies de l'Enfant et de l'Adolescent" (LEA) cohort of childhood leukemia survivors. During each medical visit, data on previous osteonecrosis diagnosis were retrospectively collected. Patients without a history but with suggestive symptoms were investigated with magnetic resonance imaging. The total steroid dose in equivalent of prednisone was calculated for each patient and its effect on osteonecrosis occurrence was studied in multivariate models. Cumulative incidence was 1.4% after chemotherapy alone versus 6.8% after transplantation (P<0.001). A higher cumulative steroid dose, age over ten years at diagnosis, and treatment with transplantation significantly increased the risk of osteonecrosis. A higher post-transplant steroid dose and age over ten years at time of transplantation were significant factors in the transplanted group. With patients grouped according to steroid dose quartile, cumulative incidence of osteonecrosis reached 3.8% in the chemotherapy group for a dose beyond 5835 mg/m(2) and 23.8% after transplantation for a post-transplant dose higher than 2055 mg/m(2). Mean physical composite score of Quality of Life was 44.3 in patients with osteonecrosis versus 54.8% in patients without (P<0.001). We conclude that total and post-transplant cumulative steroid dose may predict the risk of osteonecrosis, a rare late effect with a strong negative impact on physical domains of Quality of Life.
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Affiliation(s)
- Pauline Girard
- Department of Pediatric Hematology-Oncology, APHM, La Timone Hospital, Aix-Marseille University, France
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Richards S, Pui CH, Gayon P. Systematic review and meta-analysis of randomized trials of central nervous system directed therapy for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2013; 60:185-95. [PMID: 22693038 PMCID: PMC3461084 DOI: 10.1002/pbc.24228] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/16/2012] [Indexed: 11/07/2022]
Abstract
Treatment of the central nervous system (CNS) is an essential therapy component for childhood acute lymphoblastic leukemia (ALL). Individual patient data from 47 trials addressing 16 CNS treatment comparisons were analyzed. Event-free survival (EFS) was similar for radiotherapy versus intrathecal (IT), and radiotherapy plus IT versus IV methotrexate (IV MTX) plus IT. Triple intrathecal therapy (TIT) gave similar EFS but poorer survival than intrathecal methotrexate (IT MTX), but additional IV MTX improved both outcomes. One trial resulted in similar EFS and survival with IV MTX plus IT MTX versus TIT alone. Radiotherapy can generally be replaced by IT therapy. TIT should be used with effective systemic therapy such as IV MTX.
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Stanulla M, Bourquin JP. [Treatment of acute lymphoblastic leukemia in childhood: state of things and outlook for the future]. ACTA ACUST UNITED AC 2012; 41:203-13. [PMID: 22844667 DOI: 10.1002/pauz.201200469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Martin Stanulla
- Kinderklinik am Universitätsklinikum, Schleswig-Holstein, Campus Kiel, Kiel.
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Benoit Y, Suciu S, Cavé H, Ferster A, Dastugue N, Lutz P, Mazingue F, Robert A, Uyttebroeck A, Norton L, Sirvent N, Rohrlich P, Karrasch M, Bertrand Y. The EORTC Children's Leukemia Group: Preclinical and clinical research and resulting achievements. EJC Suppl 2012. [DOI: 10.1016/s1359-6349(12)70009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Blanco E, Beyene J, Maloney AM, Almeida R, Ethier MC, Winick N, Alexander S, Sung L. Non-relapse mortality in pediatric acute lymphoblastic leukemia: a systematic review and meta-analysis. Leuk Lymphoma 2012; 53:878-85. [PMID: 22066711 DOI: 10.3109/10428194.2011.639018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The primary objective of the study was to describe non-relapse mortality (NRM) and the proportion of first events that are deaths in children with acute lymphoblastic leukemia (ALL). Secondary objectives were to identify groups at higher risk and to determine whether proportions have changed over time. We performed a systematic review of randomized pediatric ALL studies. From 1337 articles, 59 were included, comprising a total of 49 071 patients. The induction death rate was 1.38%, remission death rate was 1.94% and total NRM was 3.60%. Deaths were responsible for 53.84% of first events during induction and 13.03% in total. Standard risk patients had significantly lower NRM during remission. The year of study was not associated with NRM. The results of the study show that the rate of NRM in children with ALL is 3.60% and those with high risk ALL have significantly higher NRM during remission, but NRM has not changed over time. Future research should focus on the exploration of patient-related risk factors for NRM.
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Affiliation(s)
- Esther Blanco
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada,
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Renard M, Suciu S, Bertrand Y, Uyttebroeck A, Ferster A, van der Werff Ten Bosch J, Mazingue F, Plouvier E, Robert A, Boutard P, Millot F, Munzer M, Mechinaud F, Lescoeur B, Baila L, Vandecruys E, Benoit Y, Philippet P. Second neoplasm in children treated in EORTC 58881 trial for acute lymphoblastic malignancies: low incidence of CNS tumours. Pediatr Blood Cancer 2011; 57:119-25. [PMID: 21412967 DOI: 10.1002/pbc.23083] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 01/20/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intensive chemotherapy has markedly improved the survival of children with acute lymphoblastic leukaemia (ALL) or lymphoblastic lymphoma (LL). Evaluation of late effects and analysis of factors contributing to their occurrence has become of major importance. Second neoplasm (SN) belongs to the most severe late events. PROCEDURE We report the incidence of SN which occurred in patients recruited in EORTC trial 58881 for children with ALL or LL. The front-line treatment regimen was adapted from the BFM protocol, but did not include cranial radiotherapy, even in patients with initial involvement of the central nervous system. A total of 2,216 patients were recruited, of whom 2,136 achieved complete remission (CR). RESULTS At a median follow-up of 7.5 years, 22 (1%) patients developed a SN: 20 during or after completion of front-line therapy and 2 in second CR, after relapse treatment including haematopoietic stem cell transplantation (HSCT). Ten patients developed acute myeloblastic leukaemia. Only one SN, a glioblastoma, was a brain tumour. Other SN were: two Hodgkin lymphomas, one non-Hodgkin lymphoma, two thyroid cancers, one osteosarcoma, two soft tissue sarcomas, one Ewing sarcoma, one cutaneous histiocytosis and one peritoneal carcinomatosis. The cumulative incidences of SN at 5, 8 and 13 years after registration were 0.8% (SE 0.2%), 1.0% (SE 0.2%) and 3.0% (SE 1.9%), respectively. CONCLUSION The overall incidence rate of SN is comparable to that reported previously. In spite of short follow-up time, the low incidence of brain tumours might be related to the omission of cranial radiotherapy.
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Vandecruys E, Mondelaers V, De Wolf D, Benoit Y, Suys B. Late cardiotoxicity after low dose of anthracycline therapy for acute lymphoblastic leukemia in childhood. J Cancer Surviv 2011; 6:95-101. [PMID: 21630046 PMCID: PMC3279635 DOI: 10.1007/s11764-011-0186-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 05/16/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Late cardiotoxicity is a known complication of anthracycline therapy but the long-term effects of low cumulative doses are not well documented. We studied late cardiotoxicity in survivors of childhood acute lymphoblastic leukemia (ALL) treated with low anthracycline doses 10 to 20 years earlier. METHODS Seventy-seven ALL survivors who received a cumulative anthracycline dose <250 mg/m² and were at least 10 years after treatment were evaluated for signs of clinical heart failure. Cardiac function was assessed by echocardiography including tissue Doppler measurements of the septal mitral annulus in 37 ALL survivors 10.6-18.3 years (median 13.3 years) after anthracycline treatment with cumulative doses of 180 (n = 19) or 240 mg/m² (n = 18). The control group consisted of 30 healthy volunteers matched for age, sex, BSA, and BMI. RESULTS No clinical relevant cardiotoxicity was found. Left ventricular shortening fraction (SF) was significantly reduced in male ALL survivors. Three of the 19 male ALL survivors had an SF below 30%. Male ALL survivors showed a significantly lower early filling velocity to atrial contraction velocity ratio but myocardial velocity during early filling was comparable between patients and controls. ALL survivors had a significantly longer isovolumetric relaxation time (IVRT). Thirty percent of the ALL survivors have an abnormal IVRT compared to the normal range of the controls. CONCLUSION AND IMPLICATIONS FOR CANCER SURVIVORS At a median of 13.3 years after exposure to cumulative doses of anthracyclines of 180 or 240 mg/m², no clinical relevant cardiotoxicity was found but subclinical cardiac abnormalities were present in 30% of the patients.
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Affiliation(s)
- Els Vandecruys
- Department of Pediatric Hemato-Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
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Lund B, Åsberg A, Heyman M, Kanerva J, Harila-Saari A, Hasle H, Söderhäll S, Jónsson ÓG, Lydersen S, Schmiegelow K. Risk factors for treatment related mortality in childhood acute lymphoblastic leukaemia. Pediatr Blood Cancer 2011; 56:551-9. [PMID: 21298739 DOI: 10.1002/pbc.22719] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 05/25/2010] [Indexed: 11/12/2022]
Abstract
BACKGROUND In spite of major improvements in the cure rate of childhood acute lymphoblastic leukaemia (ALL), 2-4% of patients still die from treatment related complications. PROCEDURE We investigated the pattern of treatment related deaths (TRDs) and possible risk factors in the NOPHO ALL-92 and ALL-2000 protocols. Fifty-five TRDs were identified among the 1,645 ALL-92 patients and 33 among the 1,090 ALL-2000 patients. RESULTS There was no significant difference in the incidence of TRDs between the two protocols (3.4% vs. 3.2%). Five patients died before initiation of therapy (0.2%), and the overall subsequent risk of induction death and death in first complete remission (CR1) was 1.2% and 1.8%, respectively. Infections were the major cause of death comprising 72% of all cases including 9 deaths from Pseudomonas aeruginosa and 11 deaths from fungal infections. Other causes of death included bleeding or thrombosis (eight patients), tumour burden related toxicities (seven patients) and organ toxicity (seven patients). Female gender (hazard ratio (HR): 2.2, 95% confidence interval (95% CI): 1.4-3.4), high white blood cell count (≥ 200 × 10(9) /L) at diagnosis (HR: 3.5, 95% CI: 1.7-7.1), T-cell disease (HR: 1.9, 95% CI: 1.01-3.7), Down syndrome (HR: 7.3, 95% CI: 3.6-14.9) and haematopoietic stem cell transplantation in CR1 (HR: 8.0, 95% CI: 3.3-19.5) were identified as independent risk factors for TRD. CONCLUSION Several TRDs were potentially preventable and future efforts should be directed towards patients at risk.
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Affiliation(s)
- Bendik Lund
- Department of Pediatrics, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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Ducassou S, Ferlay C, Bergeron C, Girard S, Laureys G, Pacquement H, Plantaz D, Lutz P, Vannier JP, Uyttebroeck A, Bertrand Y. Clinical presentation, evolution, and prognosis of precursor B-cell lymphoblastic lymphoma in trials LMT96, EORTC 58881, and EORTC 58951. Br J Haematol 2011; 152:441-51. [DOI: 10.1111/j.1365-2141.2010.08541.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sirvent N, Suciu S, Rialland X, Millot F, Benoit Y, Plantaz D, Ferster A, Robert A, Lutz P, Nelken B, Plouvier E, Norton L, Bertrand Y, Otten J. Prognostic significance of the initial cerebro-spinal fluid (CSF) involvement of children with acute lymphoblastic leukaemia (ALL) treated without cranial irradiation: results of European Organization for Research and Treatment of Cancer (EORTC) Children Leukemia Group study 58881. Eur J Cancer 2010; 47:239-47. [PMID: 21095115 DOI: 10.1016/j.ejca.2010.10.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 10/08/2010] [Accepted: 10/22/2010] [Indexed: 10/18/2022]
Abstract
AIM OF THE STUDY To evaluate the prognostic significance of the initial cerebro-spinal fluid (CSF) involvement of children with ALL enrolled from 1989 to 1996 in the EORTC 58881 trial. PATIENTS AND METHODS Patients (2025) were categorised according to initial central nervous system (CNS) status: CNS-1 (CNS negative, n=1866), CNS-2 (<5 leucocytes/mm(3), CSF with blasts, n=50), CNS-3 (CNS positive, n=49), TLP+ (TLP with blasts, n=60). CNS-directed therapy consisted in intravenous (i.v.) methotrexate (5 g/sqm) in 4-10 courses, and intrathecal methotrexate injections (10-20), according to CNS status. Cranial irradiation was omitted in all patients. RESULTS In the CNS1, TLP+, CNS2 and CNS3 group the 8-year EFS rate (SE%) was 69.7% (1.1%), 68.8% (6.2%), 71.3% (6.5%) and 68.3% (6.2%), respectively. The 8-year incidence of isolated CNS relapse (SE%) was 3.4% (0.4%), 1.7% (1.7%), 6.1% (3.5%) and 9.4% (4.5%), respectively, whereas the 8-year isolated or combined CNS relapse incidence was 7.6% (0.6%), 3.5% (2.4%), 10.2% (4.4%) and 11.7% (5.0%), respectively. Patients with CSF blasts had a higher rate of initial bad risk features. Multivariate analysis indicated that presence of blasts in the CSF had no prognostic value: (i) for EFS and OS; (ii) for isolated and isolated or combined CNS relapse; WBC count<25 × 10(9)/L and Medac E-coli asparaginase treatment were each related to a lower CNS relapse risk. CONCLUSIONS The presence of initial CNS involvement has no prognostic significance in EORTC 58881. Intensification of CNS-directed chemotherapy, without CNS radiation, is an effective treatment of initial meningeal leukaemic involvement.
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49
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NOTCH1 and FBXW7 mutations have a favorable impact on early response to treatment, but not on outcome, in children with T-cell acute lymphoblastic leukemia (T-ALL) treated on EORTC trials 58881 and 58951. Leukemia 2010; 24:2023-31. [PMID: 20861920 DOI: 10.1038/leu.2010.205] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Risk-adjusted treatment stratification in T-cell acute lymphoblastic leukemias (T-ALLs) is currently based only on early response to chemotherapy. We investigated the prognostic implication of hyperactivation of NOTCH pathway resulting from mutations of NOTCH1 or FBXW7 in children with T-ALL enrolled in EORTC-CLG trials. Overall, 80 out of 134 (60%) patients were NOTCH+ (NOTCH1 and/or FBXW7 mutated). Although clinical presentations were not significantly associated with NOTCH status, NOTCH+ patients showed a better early response to chemotherapy as compared with NOTCH- patients, according to the rate of poor pre-phase 'responders' (25% versus 44%; P=0.02) and the incidence of high minimal residual disease (MRD) levels (11% (7/62) versus 32% (10/31); P=0.01) at completion of induction. However, the outcome of NOTCH+ patients was similar to that of NOTCH- patients, with a 5-year event-free survival (EFS) of 73% and 70% (P=0.82), and 5-year overall survival of 82% and 79% (P=0.62), respectively. In patients with high MRD levels, the 5-year EFS rate was 0% (NOTCH+) versus 42% (NOTCH-), whereas in those with low MRD levels, the outcome was similar: 76% (NOTCH+) versus 78% (NOTCH-). The incidence of isolated central nervous system (CNS) relapses was relatively high in NOTCH1+ patients (8.3%), which could be related to a higher propensity of NOTCH+ leukemic blasts to target the CNS.
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50
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De Moerloose B, Suciu S, Bertrand Y, Mazingue F, Robert A, Uyttebroeck A, Yakouben K, Ferster A, Margueritte G, Lutz P, Munzer M, Sirvent N, Norton L, Boutard P, Plantaz D, Millot F, Philippet P, Baila L, Benoit Y, Otten J. Improved outcome with pulses of vincristine and corticosteroids in continuation therapy of children with average risk acute lymphoblastic leukemia (ALL) and lymphoblastic non-Hodgkin lymphoma (NHL): report of the EORTC randomized phase 3 trial 58951. Blood 2010; 116:36-44. [PMID: 20407035 PMCID: PMC2904579 DOI: 10.1182/blood-2009-10-247965] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 03/23/2010] [Indexed: 11/20/2022] Open
Abstract
The European Organisation for Research and Treatment of Cancer 58951 trial for children with acute lymphoblastic leukemia (ALL) or non-Hodgkin lymphoma (NHL) addressed 3 randomized questions, including the evaluation of dexamethasone (DEX) versus prednisolone (PRED) in induction and, for average-risk patients, the evaluation of vincristine and corticosteroid pulses during continuation therapy. The corticosteroid used in the pulses was that assigned at induction. Overall, 411 patients were randomly assigned: 202 initially randomly assigned to PRED (60 mg/m(2)/d), 201 to DEX (6 mg/m(2)/d), and 8 nonrandomly assigned to PRED. At a median follow-up of 6.3 years, there were 19 versus 34 events for pulses versus no pulses; 6-year disease-free survival (DFS) rate was 90.6% (standard error [SE], 2.1%) and 82.8% (SE, 2.8%), respectively (hazard ratio [HR] = 0.54; 95% confidence interval, 0.31-0.94; P = .027). The effect of pulses was similar in the PRED (HR = 0.56) and DEX groups (HR = 0.59) but more pronounced in girls (HR = 0.24) than in boys (HR = 0.71). Grade 3 to 4 hepatic toxicity was 30% versus 40% in pulses versus no pulses group and grade 2 to 3 osteonecrosis was 4.4% versus 2%. For average-risk patients treated according to Berlin-Frankfurt-Muenster-based protocols, pulses should become a standard component of therapy.
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Affiliation(s)
- Barbara De Moerloose
- Department of Pediatric Hematology-Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
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