Long-term results of the Italian Association of Pediatric Hematology and Oncology (AIEOP) Acute Lymphoblastic Leukemia Studies, 1982–1995

Abstract

The first multicentric approach to childhood acute lymphoblastic leukemia (ALL) treatment in Italy started in the early 1970s when the Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIEOP) was founded. Since then the AIEOP has conducted nationwide chemotherapy protocols. Results obtained in three different periods (1982-1986, 1987-1990, 1991-1995) are reported here. Treatment schedules have been characterized by a progressive intensification of systemic therapy and by a progressive substitution of protracted intrathecal therapy for cranial irradiation as central nervous system (CNS) preventive therapy. In the third period cranial radiotherapy (CRT) has been administered only to patients at high risk of relapse or with CNS involvement at diagnosis (about 15% of the overall population). A progressive improvement of therapeutic results, with a steady reduction of isolated CNS relapse rates have been obtained in the three periods considered here. The AIEOP experience shows that CRT can be safely omitted in non-high risk patients, unless they are T-ALL patients with WBC count at the diagnosis у100 000/mm 3 , and that intensification of treatment allows the improvement of overall results with a reduction of the impact of NCI prognostic criteria. Over the years, AIEOP has also continued to foster active cooperation at an international level. In the ongoing AIEOP ALL 2000 study, conducted in cooperation with the BFM group, patients are stratified according to the presence of translocations t(9;22) and t(4;11) and to treatment response (either initial steroid therapy or induction) or minimal residual disease). This cooperation will allow an adequate recruitment of patients to answer relevant randomized questions in the context of a study in which patients are stratified according to minimal residual disease findings. Leukemia (2000) 14, 2196-2204.

Acute lymphoblastic leukemia and Down syndrome

“…Yet, 70% of them received an intensive, BFM-based chemotherapy. 21 Leukemia relapse occurred mainly in the bone marrow; the likely explanation for this is the reduced treatment intensity induced by inherent risk of infection in these constitutively immune-compromised patients. This is in keeping with the finding of the BFM group reporting that among 61 DS patients from trials ALL-BFM 81, 83, 86, and 90, EFS was comparable to that of the non-DS group once they received treatment with no major modifications.…”

“…20,21 Whereas the traditional cutoff age for eligibility had been younger than 15 years, starting with the most recent studies, AIEOP-ALL-95 and AIEOP-BFM-ALL-2000, the cutoff age was extended to younger than 18 years.…”

Long-term results of the Italian Association of Pediatric Hematology and Oncology (AIEOP) Studies 82, 87, 88, 91 and 95 for childhood acute lymphoblastic leukemia

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] In the earlier studies conducted in the 70s, all patients received a relatively low-intensity chemotherapy and cranial radiotherapy (CRT). In Study 82, patients were stratified into three risk groups.…”

“…It provides 15-year updated figures for studies 82,87,88,91 reported earlier in Leukemia 13 and newly presents long-term results of Study 95.…”

International childhood Acute Lymphoblastic Leukemia workshop: Sausalito, CA, 30 November–1 December 2000

“…The intent was to identify effective treatment for certain well-defined subsets of patients. This unprecedented effort resulted in 12 informative articles published together in the December 2000 issue of Leukemia, [5][6][7][8][9][10][11][12][13][14][15][16] providing valuable clues to advance the cure rate in future trials.…”