Postrelapse survival in childhood acute lymphoblastic leukemia is independent of initial treatment intensity: a report from the Children's Oncology Group

Freyer, David R.; Devidas, Meenakshi; La, Marzano; Carroll, William L.; Gaynon, Paul S.; Hunger, Stephen P.; Seibel, Nita L.

doi:10.1182/blood-2010-07-294678

Cited by 73 publications

(60 citation statements)

References 42 publications

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“…25,39 Finally, our data on ETV6/RUNX1-positive ALL from the FRALLE 93 study can probably be extended to other first-line protocols because Freyer et al recently showed that postrelapse survival in relapsed childhood ALL was independent of initial treatment intensity. 38 In conclusion, the prognosis of patients with relapses of ETV6/RUNX1-positive ALL occurring more than 36 months after diagnosis is excellent. Testicular relapses are particularly common which suggests that a primary treatment able to cross the testicular barrier should be used and that follow-up should be prolonged with careful screening of the gonads.…”

Section: Discussionmentioning

confidence: 99%

“…However, the poor survival rate of patients with early relapses encourages the use of a second-line treatment with cell therapy according to the REZ-BFM. In both types of relapse, 38 clinical decisions could also be helped by assessing the dynamics of treatment response using minimal residual disease quantification, which is a promising strategy being validated in ongoing relapse trials. 25,39 Finally, our data on ETV6/RUNX1-positive ALL from the FRALLE 93 study can probably be extended to other first-line protocols because Freyer et al recently showed that postrelapse survival in relapsed childhood ALL was independent of initial treatment intensity.…”

Section: Discussionmentioning

confidence: 99%

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Excellent prognosis of late relapses of ETV6/RUNX1-positive childhood acute lymphoblastic leukemia: lessons from the FRALLE 93 protocol

Gandemer

Chevret

Petit³

et al. 2012

Haematologica

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The online version of this article has a Supplementary Appendix. BackgroundThe prognosis of patients with relapses of ETV6/RUNX1-positive acute lymphoblastic leukemia remains to be evaluated, particularly with regards to the frequency of late relapses. We performed a long-term, follow-up retrospective study to address the outcome of patients with ETV6/RUNX1-positive leukemia relapses. Design and MethodsAmong the 713 children tested for ETV6/RUNX1 enrolled into the FRALLE 93 protocol, 43 ETV6/RUNX1-positive patients relapsed (19.4%). Most were initially stratified in the low or intermediate risk groups. The median follow-up after relapse was 54.2 months. All but three received second-line salvage therapy and 16 underwent allogeneic transplantation. ResultsETV6/RUNX1 had a strong effect on overall survival after relapse (3-year survival= 64.7% for positive cases versus 46.5% for negative cases) (P=0.007). The 5-year cumulative incidence of relapse was 19.4% and testes were more frequently involved in ETV6/RUNX1-positive relapses (P=0.04). In 81.4% of cases the relapses were late, early combined or isolated extramedullary relapses. The 5-year survival rate of patients with ETV6-RUNX1-positive acute lymphoblastic leukemia relapses reached 80.8% when the relapse occurred after 36 months (versus 31.2% when the relapse occurred earlier). In univariate analysis, female gender was associated with a poor survival, whereas site of relapse, age at diagnosis, leukocytosis and consolidation strategy had no effect. In multivariate analysis, only the duration of first remission remained associated with outcome. ConclusionsWe found an excellent outcome for patients with ETV6/RUNX1-positive leukemia relapses that occurred more than 36 months after diagnosis. The duration of first complete remission may, therefore, be a guide to define the treatment strategy for patients with relapsed ETV6/RUNX1-positive leukemia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Excellent prognosis of late relapses of ETV6/RUNX1-positive childhood acute lymphoblastic leukemia: lessons from the FRALLE 93 protocol

Gandemer

Chevret

Petit³

et al. 2012

Haematologica

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“…In recent years significantly increased the effectiveness of ALL treatment in the pediatric group of patients (Freyer et al, 2011). Surveillance, Epidemiology and End Results register (SEER) analysis showed the biggest improvement in survival of patients aged 15-19 years because the 5-year overall survival increased from 41 to 62%.…”

Section: Treatment Of Acute Lymphoblastic Leukemia Patientsmentioning

confidence: 99%

Genetic Studies in Acute Lymphoblastic Leukemia, from Diagnosis to Optimal Patient’s Treatment

Krawczyk-Kuliś¹

2012

Recent Trends in Cytogenetic Studies - Methodologies and Applications

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“…13 Contributing to the inferior OS of older patients is the observation that those Ͼ15 years of age treated for relapsed ALL have a significantly worse outcome than their younger peers. 14 Infants, those Ͻ1 year of age at the time of diagnosis, remain at very high risk of relapse, even with aggressive contemporary therapy. 15,16 Risk stratification within the infant group is based on presence of MLL gene rearrangement, found in ϳ75% and in the majority of younger infants.…”

Section: Clinical Featuresmentioning

confidence: 99%

Clinically defining and managing high-risk pediatric patients with acute lymphoblastic leukemia

Alexander

2014

Hematology

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For children with acute lymphoblastic leukemia, the identification of those at higher risk of disease recurrence and modifying therapy based on this risk is a critical component to the provision of optimal care. The specific definitions of high-risk ALL vary across cooperative groups, but the themes are consistent, being largely based on leukemia biology and disease response. Intensification of conventional chemotherapy for those with high-risk disease has led to improved outcomes. It is anticipated that the development of rational targeted therapy for specific biologically unique subsets of children with leukemia will contribute to ongoing progress in improving the outcomes for children with acute lymphoblastic anemia. Learning Objectives• To understand current criteria used to identify children with high-risk ALL • To understand therapeutic strategies for children with highrisk ALL

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Postrelapse survival in childhood acute lymphoblastic leukemia is independent of initial treatment intensity: a report from the Children's Oncology Group

Abstract: While intensification of therapy has improved event-free survival (EFS) and survival in newly diagnosed

Cited by 73 publications

References 42 publications

Excellent prognosis of late relapses of ETV6/RUNX1-positive childhood acute lymphoblastic leukemia: lessons from the FRALLE 93 protocol

Excellent prognosis of late relapses of ETV6/RUNX1-positive childhood acute lymphoblastic leukemia: lessons from the FRALLE 93 protocol

Genetic Studies in Acute Lymphoblastic Leukemia, from Diagnosis to Optimal Patient’s Treatment

Clinically defining and managing high-risk pediatric patients with acute lymphoblastic leukemia

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