Treatment of occult or late overt testicular relapse in children with acute lymphoblastic leukemia: a Pediatric Oncology Group study.

Wofford, Marcia M.; Smith, Stephen D.; Shuster, JJ; Johnson, W. J.; Buchanan, G. R.; Wharam, Moody D.; Ritchey, A. Kim; Rosen, David; Haggard, Mary Ellen; Golembe, Barry

doi:10.1200/jco.1992.10.4.624

Cited by 52 publications

(29 citation statements)

References 32 publications

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“…Since all were late testicular relapses, they would be expected to have an excellent salvage rate. 13 Isolated CNS relapse (n ‫؍‬ 12). There were 12 patients with isolated CNS relapse as their initial event of whom 3 were diagnosed on treatment at weeks 84, 97, and 97.…”

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Antimetabolite therapy for lesser-risk B-lineage acute lymphoblastic leukemia of childhood: a report from Children's Oncology Group Study P9201

Chauvenet

Martin

Devidas

et al. 2007

Blood

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Pediatric Oncology Group (POG) protocol 9201 enrolled children with lesser-risk Blineage acute lymphoblastic leukemia (ALL) defined by age (1-9), white blood cell count (WBC) less than 50 ؋ 10 9 /L (50 000/L), DNA findings of trisomies 4 and 10 (or DNA index > 1.16), and lack of overt central nervous system (CNS) leukemia. After vincristine, prednisone, and asparaginase induction, 650 of 653 eligible patients attained remission (3 induction deaths) and received 6 courses of intravenous methotrexate (1 g/m 2 ) with daily mercaptopurine.Weekly intramuscular methotrexate was added during maintenance; pulses of vincristine and prednisone were administered with periodic intrathecal chemotherapy. Treatment duration was 2.5 years. No alkylators, epipodophylotoxins, anthracyclines, or radiation were given. The 6-year event-free survival (EFS) was 86.6% with overall survival (OS) of 97.2%. Patients with less than 5% marrow blasts on induction day 15 had superior EFS. A difference not reaching conventional statistical significance (P ‫؍‬ . IntroductionB-lineage acute lymphoblastic leukemia (ALL) is the most common childhood malignancy in industrialized countries. 1 Multiple different treatments have produced cures for a majority of children with ALL. 2,3 A wide variety of prognostic factors have been used to separate patients into those of lesser risk and higher risk. The Pediatric Oncology Group (POG) previously recognized patients with "favorable" age and initial white blood cell count (WBC) by National Cancer Institute common risk group criteria 4 whose blasts have an elevated DNA index or trisomy of both chromosomes 4 and 10 in their leukemic cells to have an exceptionally good prognosis when treated with antimetabolite therapy, 5 a finding supported by other studies. 6,7 Because of the potential shortand long-term burden of therapy, POG 9201 was designed to extend this observation to a larger set of patients, attempting to clearly define a group of patients with an excellent prognosis even when treated with less-intensive treatment. Patients, materials, and methods PatientsThe POG 9201 protocol opened as a limited institution pilot study in June 1992 and as a nonrandomized single-arm phase 3 group-wide study in November 1994. The study met accrual goals and closed to new patient enrollment in November 1999. Patients eligible for enrollment were diagnosed with B-lineage ALL (confirmed by a central POG laboratory), aged 1 to 9 years, and had an initial WBC less than 50 ϫ 10 9 /L (50 000/L). Evidence of trisomies 4 and 10 was required if cytogenetics were abnormal (informative); it was assumed that "normal" cytogenetic studies might reflect lack of cell growth or division in the sample, and demonstration of a DNA index more than 1.16 was allowed as a surrogate marker; DNA index was determined by a POG reference laboratory and all cytogenetics were either determined centrally or centrally reviewed by one of the authors (A.J.C.). Fluorescence in situ hybridization (FISH), to determine trisomies of chromosomes 4 and 10, wa...

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Antimetabolite therapy for lesser-risk B-lineage acute lymphoblastic leukemia of childhood: a report from Children's Oncology Group Study P9201

Chauvenet

Martin

Devidas

et al. 2007

Blood

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“…In a large Scandinavian study, Nygaard et al [6] report on a patient with isolated testicular relapse after 13.7 years of remission and Woford et al [7] published a case with a relapsefree interval of 10.9 years. Among the boys treated in the German BFM-ALL studies 1970-1979 one patient suffered testicular relapse 11 years after the initial diagnosis [Riehm, personal commun.].…”

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Testicular Relapse after 13 Years of Complete Remission of Acute Lymphoblastic Leukemia

Franck

Duffner²,

Schulze-Seemann³

et al. 1998

Urol Int

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Girls with acute lymphoblastic leukemia appear to have a higher cure rate than boys. This is in part attributable to the reoccurrence of testicular disease in boys. Although the frequency of testicular relapse is less than 5% with current intensive therapy regimens, testicular disease remains of apparent clinical importance. Here we report an unusually late testicular relapse in an 18-year-old male after 12.7 years of continuous complete remission, and review the literature regarding this late failure.

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“…The incidence in their series is a whopping 9.5% (27% of all relapses in boys), which is much like the middle era of ALL therapy and is higher than most current series. [7,8] This seems to be obviously because of usage of 3 drug induction and non-methotrexate-based consolidation in all newcomers irrespective of risk-group. Biologic differences from the West are unlikely since in a recent Indian series, the incidence of testicular relapse was 4.4%.…”

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Relapsed testicular leukemia: Local insights in to a vanishing disease

Arora

2010

Indian J Cancer

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Childhood acute lymphoblastic leukemia (ALL) is the single most common childhood malignancy. It comprises almost one-fourth of cancers in children ages 0-15 years. At least 25-30% of patients have relapse with current therapies, making relapsed ALL the fourth most common malignancy in children after newly diagnosed ALL, astrocytoma and neuroblastoma. Indeed, relapsed ALL is the second most common leukemia in children and is more common than newly diagnosed non-Hodgkin's lymphoma, Wilms' tumor, Hodgkin's disease and primitive neuroectodermal tumors. [1]

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Treatment of occult or late overt testicular relapse in children with acute lymphoblastic leukemia: a Pediatric Oncology Group study.

Abstract: The treatment approach reported here can secure a prolonged second remission in many patients with occult or late overt testicular leukemia.

Cited by 52 publications

References 32 publications

Antimetabolite therapy for lesser-risk B-lineage acute lymphoblastic leukemia of childhood: a report from Children's Oncology Group Study P9201

Antimetabolite therapy for lesser-risk B-lineage acute lymphoblastic leukemia of childhood: a report from Children's Oncology Group Study P9201

Testicular Relapse after 13 Years of Complete Remission of Acute Lymphoblastic Leukemia

Relapsed testicular leukemia: Local insights in to a vanishing disease

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