The impact of risk stratification by early bone‐marrow response in childhood lymphoblastic leukaemia: results from the United Kingdom Medical Research Council trial ALL97 and ALL97/99

Abstract

Summary The 1997 acute lymphoblastic leukaemia (ALL) trial (ALL97) was a randomised comparison of prednisolone versus dexamethasone and of 6‐mercaptopurine versus 6‐thioguanine. During the first 2 years of the trial, review of survival data showed the preceding trial, UKALL XI, was no better than its predecessor and that survival for childhood ALL in the UK had not improved in the fashion witnessed by other cooperative treatment groups. The therapy template was therefore altered to an American Children’s Cancer Group (CCG) style regimen, including stratification by age, white cell count and early response to therapy by assessment of the bone marrow. This phase of the trial was designated ALL97/99. Comparison of the two phases showed that the event‐free survival (EFS) for both ALL97 and ALL97/99 was better than previous UKALL trials, as was overall survival (OS) for ALL97/99. Both EFS and OS were significantly better in ALL97/99 than in ALL97 (at five years, 80·0% vs. 74·0%, P = 0·002; and 88·0% vs. 83·5%, P = 0·005, respectively). Isolated central nervous system (CNS) relapse for patients in ALL97/99 was half that in ALL97 (3·0% vs. 4·9%), P = 0·03) and the overall CNS relapse rate was halved in ALL97/99 (4·4% vs. 9·6%, P < 0·00005). There were no significant differences for non‐CNS relapse, induction deaths or deaths in remission between the two phases of the trial.

Demographic, clinical, and outcome features of children with acute lymphoblastic leukemia and CRLF2 deregulation: results from the MRC ALL97 clinical trial

“…1,2,4,5 Overall, CRLF2 deregulation (CRLF2-d) occurs in 5%-7% of childhood acute lymphoblastic leukemia (ALL) but is more frequent among Down syndrome (DS) patients, where it occurs in 50% of cases. 1,2,4 To assess the incidence and clinical and prognostic relevance of CRLF2-d in pediatric ALL, we screened 865 B-cell precursor ALL (BCP-ALL) patients treated in the trial Medical Research Council (MRC) ALL97 [6][7][8][9] for the presence of this abnormality and evaluated its effect on outcome within the context of other risk factors.…”

The frequency and prognostic impact of dic(9;20)(p13.2;q11.2) in childhood B-cell precursor acute lymphoblastic leukemia: results from the NOPHO ALL-2000 trial

“…The strategies for Ara-C treatments are largely similar in the three protocols. 17,22,24 Thus, one could speculate that these drugs, when given as in the BFM protocol, may contribute to the more favorable outcome seen in the BFM study. 6 If correct, it becomes even more important to identify all dic(9;20)-positive cases using an interphase FISH strategy in order to assign the patients to correct risk groups and proper treatment regimens.…”

Dexamethasone versus prednisone for induction therapy in childhood acute lymphoblastic leukemia: a systematic review and meta-analysis

“…The reasons for excluding 15 articles are shown in Figure 1. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Characteristics of included studies are presented in Table 1 (patients in trial Risk of bias assessment has been hampered by the fact that four of the eight studies, so far, have only published preliminary data in form of conference abstracts (AIEOP-BFM ALL 2000 and ALL-BFM 2000, respectively; COG AALL0232, EORTC 58951). Considering all trials, allocation generation and concealment information were available for one and two trials, respectively.…”