Augmented Post-Induction Therapy for Children with High-Risk Acute Lymphoblastic Leukemia and a Slow Response to Initial Therapy

Nachman, James B.; Sather, Harland N.; Sensel, Martha G.; Trigg, Michael E.; Cherlow, Joel M.; Lukens, John N.; Wolff, Lawrence J.; Uckun, Fatih M.; Gaynon, Paul S.

doi:10.1056/nejm199806043382304

Cited by 405 publications

(212 citation statements)

References 41 publications

Supporting

Mentioning

197

Contrasting

Unclassified

Order By: Relevance

“…Add-on therapy (augmented BFM concept) has also shown to increase the efficacy of that phase. 62 In HR patients any intervention can be monitored very efficiently through quantitative PCR detection of minimal residual disease. 20,63,64 (4) Interim consolidation (also called interim maintenance):…”

Section: Discussionmentioning

confidence: 99%

Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000

Möricke¹,

Zimmermann

Reiter³

et al. 2009

Leukemia

465

303

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000

Möricke¹,

Zimmermann

Reiter³

et al. 2009

Leukemia

465

303

View full text Add to dashboard Cite

“…After initiation of therapy, modifications in stratification are made based on response to treatment (ie, prednisone window, Day 7 of 14 bone marrow morphology). 2,6 Similarly, the major prognostic factors in pediatric AML are morphology/phenotype (M3), cytogenetics (trisomy 21, monosomy 7, 5q2), and response to therapy. In an effort to identify more patients who will ultimately experience recurrence, measurement of minimal residual disease (MRD) after induction appears to be an important prognostic factor in both ALL and AML and is being evaluated in current clinical trials.…”

Section: Risk Stratificationmentioning

confidence: 99%

“…1 Although most patients enter remission initially, over 25% of patients will ultimately experience a relapse, and those patients with an early bone marrow relapse have <10% survival. 2 Similarly, 50% of acute myeloblastic leukemia (AML) patients will relapse. 3 Although salvage regimens including bone marrow transplant are modestly successful in a subset of young patients, durable remissions remain elusive for most with recurring AML.…”

mentioning

confidence: 99%

Absolute lymphocyte count is a novel prognostic indicator in ALL and AML

Angulo¹,

Yuen²,

Palla³

et al. 2007

Cancer

112

View full text Add to dashboard Cite

BACKGROUND.Leukemia is the leading cause of disease‐related death in children, despite significant improvement in survival and modern risk stratification. The prognostic significance of absolute lymphocyte counts (ALC) was evaluated in young patients with acute myeloblastic leukemia (AML) and acute lymphoblastic leukemia (ALL).METHODS.In all, 171 consecutive de novo cases of AML and ALL, age ≤21 years, were analyzed. Age, initial white blood cell count, cytogenetics, and bone marrow response were compared with lymphocyte, neutrophil, and platelet counts at weekly intervals during induction chemotherapy.RESULTS.ALC is a significant independent predictor of relapse and survival. For example, in patients with AML an ALC on Day 28 of induction (ALC‐28) <350 cells/μL predicts very poor survival, with a 5‐year relapse‐free survival (RFS) of only 10% (hazard ratio [HR] 3.7, P = .003). In contrast, an ALC‐15 >350 cells/μL carries an excellent prognosis, with a 5‐year overall survival (OS) of 85% (HR 0.2, P = .012). Similarly in ALL, an ALC‐15 <350 cells/μL predicts poor survival, with a 6‐year RFS of 43% (HR 4.5, P = .002), whereas an ALC‐15 >350 cells/μL predicts excellent outcome, with a 6‐year OS of 87% (HR 0.2, P = .018). Importantly, ALC remains a strong predictor in multivariate analysis with known prognostic factors.CONCLUSIONS.ALC is a simple, statistically powerful measurement for patients with de novo AML and ALL. The results, when combined with previous studies, demonstrate that ALC is a powerful new prognostic factor for a range of malignancies. These findings suggest a need for further exploration of postchemotherapy immune status and immune‐modulating cancer therapies. Cancer 2008. © 2007 American Cancer Society.

show abstract

“…Examples of this are more intensive treatment for children with t(1;19) (27,28) or who demonstrate a slow response to initial therapy. 29 In conclusion, we were unable to show a statistical advantage between asparaginase (regimen B) and cytarabine (regimen C) during the intensification phase of therapy in children with B-lineage acute lymphocytic leukemia. The challenge for future treatment of ALL will be to design the most effective regimens that will improve the survival of children with both standard prognosis and high-risk ALL while decreasing both short-term and long-term side effects.…”

Section: Discussionmentioning

confidence: 63%

Treatment of children with early pre-B and pre-B acute lymphocytic leukemia with antimetabolite-based intensification regimens: a Pediatric Oncology Group Study

et al. 2000

View full text Add to dashboard Cite

Overall 5-year continuous complete remission (CCR) for regimen B was 72 ± 2% (s.e.) and for regimen C, 73 ± 2% (P = 0.72 by log-rank analysis). Significant differences between treatments for CCR, testicular, CNS relapses overall or with regard to phenotype (pre-B vs early pre-B), gender, or race were not detected. During intensification, regimen C had significantly more bacterial infections (P = 0.05) and days spent in the hospital (P Ͻ 0.001) compared with regimen B, while regimen B had significantly more allergic reactions (P Ͻ 0.0001). No significant differences in CCR were noted between patients with pre-B and early pre-B ALL (P = 0.22 stratified by risk group and treatment). This study was unable to detect statistical difference between asparaginase (regimen B) and cytarabine (regimen C) during the intensification phase of therapy in children with B-lineage acute lymphocytic leukemia. Leukemia (2000) 14, 1570-1576.

show abstract

Augmented Post-Induction Therapy for Children with High-Risk Acute Lymphoblastic Leukemia and a Slow Response to Initial Therapy

Abstract: Augmented post-induction chemotherapy results in an excellent outcome for most patients with high-risk ALL and a slow response to initial therapy.

Cited by 405 publications

References 41 publications

Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000

Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000

Absolute lymphocyte count is a novel prognostic indicator in ALL and AML

Treatment of children with early pre-B and pre-B acute lymphocytic leukemia with antimetabolite-based intensification regimens: a Pediatric Oncology Group Study

Contact Info

Product

Resources

About