Double-delayed intensification improves event-free survival for children with intermediate-risk acute lymphoblastic leukemia: a report from the Children's Cancer Group

Lange, Beverly J.; Bostrom, Bruce; Cherlow, Joel M.; Sensel, Martha G.; La, Marzano; Rackoff, Wayne; Heerema, Nyla A.; Wimmer, Robert S.; Trigg, Michael E.; Sather, Harland N.

doi:10.1182/blood.v99.3.825

Cited by 128 publications

(99 citation statements)

References 32 publications

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“…Children aged 2-9 years with white blood cell (WBC) counts o10 000/ml were treated on CCG-1881 for low-risk patients, 15 and children aged 2-9 years with WBC counts 10 000-49 999/ml or aged 12-24 months and WBC counts o50 000/ml were enrolled on CCG-1891 for intermediate-risk patients. 16 After completion of these studies, children with low-or intermediate-risk ALL were enrolled on CCG-1922. 17 High-risk patients (age X10 years and/or with WBC counts X50 000/ml) were treated on CCG-1882 18,19 or CCG-1901, for patients with multiple unfavorable features (lymphomatous syndrome).…”

Section: Patientsmentioning

confidence: 99%

Deletion of 7p or monosomy 7 in pediatric acute lymphoblastic leukemia is an adverse prognostic factor: a report from the Children's Cancer Group

et al. 2004

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Monosomy 7 or deletions of 7q are associated with many myeloid disorders; however, the significance of such abnormalities in childhood acute lymphoblastic leukemia (ALL) is unknown. Among 1880 children with ALL, 75 (4%) had losses involving chromosome 7, 16 (21%) with monosomy 7, 41 (55%) with losses of 7p (del(7p)), 16 (21%) with losses of 7q (del(7q)), and two (3%) with losses involving both arms. Patients with losses involving chromosome 7 were more likely to be X10 years old, National Cancer Institute (NCI) poor risk, and hypodiploid than patients lacking this abnormality. Patients with or without these abnormalities had similar early response to induction therapy. Event-free survival (EFS) and survival for patients with monosomy 7 (Po0.0001 and P ¼ 0.0007, respectively) or del(7p) (Po0.0001 and P ¼ 0.0001, respectively), but not of patients with del(7q), were significantly worse than those of patients lacking these abnormalities. The poorer EFS was maintained after adjustment for a Philadelphia (Ph) chromosome, NCI risk status, ploidy, or an abnormal 9p. However, the impact on survival was not maintained for monosomy 7 after adjustment for a Ph. These results indicate that the critical region of loss of chromosome 7 in pediatric ALL may be on the p-arm.

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Section: Patientsmentioning

confidence: 99%

Deletion of 7p or monosomy 7 in pediatric acute lymphoblastic leukemia is an adverse prognostic factor: a report from the Children's Cancer Group

et al. 2004

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“…1 Yet central nervous system (CNS) relapse remains a major obstacle to cure, accounting for 30% to 40% of initial relapses in some clinical trials. [2][3][4] Inadequate control of CNS leukemia is partly related to the decreased use of cranial irradiation for subclinical disease to avoid the long-term sequelae of this treatment modality. Indeed, even in patients with CNS leukemia at diagnosis or relapse, attempts have been made to reduce the dose of therapeutic cranial irradiation.…”

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confidence: 99%

Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment

Pui

2006

Hematology

105

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Improved treatment for acute lymphoblastic leukemia (ALL) has virtually eliminated testicular relapse. However, the control of central nervous system (CNS) leukemia remains a therapeutic challenge in childhood ALL, partly because of the late complications arising from cranial irradiation. In most current pediatric protocols, cranial irradiation (12 to 18 Gy) is given to 5% to 25% of patients—those with T-cell ALL, overt CNS disease (CNS3 status) or high-risk cytogenetics. CNS control is a less urgent concern in adults with ALL, in whom systemic relapse remains the major problem. With current approaches, approximately 2% to 10% of patients can be expected to develop CNS relapse. Children with B-cell precursor ALL who have a late CNS relapse (after an initial remission of 18 months or more) and did not receive cranial irradiation have an excellent outcome after retrieval therapy, with a 5-year event-free survival (EFS) rate approaching that in newly diagnosed patients. Innovative treatment options are needed for children who develop CNS relapses after a short initial remission or after receiving cranial irradiation, and in any adults with CNS leukemia at diagnosis or relapse.

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“…Following advances in chemotherapy and effective CNS prophylaxis, the incidence of CNS relapse in cases of ALL has decreased to 5-10% (1). Intrathecal administration of chemotherapy, high dose chemotherapy and brain radiotherapy are the primary measures used for the prevention of CNSL (3,4).…”

Section: Introductionmentioning

confidence: 99%

“…However, few patients (<5%) with ALL present with overt CNSL initially (1). The clinical manifestation of CNSL ranges from mild to severe, and infiltration of the arachnoid membrane and dura mater is the most common, followed by the brain parenchyma and cranial nerves; spinal cord infiltration is the most rare presentation (1,3,4).…”

Section: Introductionmentioning

confidence: 99%

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Transverse myelopathy occurring with intrathecal administration of methotrexate and cytarabine chemotherapy: A case report

Pan

Wang

et al. 2016

Oncology Letters

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Abstract. Paraplegia following spinal injury is a rare complication subsequent to the administration of intrathecal chemotherapy; however, it is also one of the rare clinical features of central nervous system leukemia (CNSL). Distinguishing between the two is extremely important. The present study reports the case of a 46-year-old man who was diagnosed with acute lymphoblastic leukemia and subsequently achieved remission in the blood and bone marrow following the initial course of chemotherapy. However, the patient developed a sudden onset of paraplegia and urinary retention due to spinal cord infiltration of leukemia cells following the administration of intrathecal methotrexate and cytarabine. The paraplegia was initially reversible. However, a few weeks later, the patient developed irreversible paraplegia due to a complication of the intrathecal administration of chemotherapy (methotrexate and cytarabine arabinoside). The patient gave up further treatment in

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Double-delayed intensification improves event-free survival for children with intermediate-risk acute lymphoblastic leukemia: a report from the Children's Cancer Group

Abstract: Addition of a delayed-intensification (DI

Cited by 128 publications

References 32 publications

Deletion of 7p or monosomy 7 in pediatric acute lymphoblastic leukemia is an adverse prognostic factor: a report from the Children's Cancer Group

Deletion of 7p or monosomy 7 in pediatric acute lymphoblastic leukemia is an adverse prognostic factor: a report from the Children's Cancer Group

Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment

Transverse myelopathy occurring with intrathecal administration of methotrexate and cytarabine chemotherapy: A case report

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