Triple Intrathecal Therapy Alone With Omission of Cranial Radiation in Children With Acute Lymphoblastic Leukemia

Liu, Hsi‐Che; Yeh, Ting‐Chi; Hou, Jen‐Yin; Chen, Kuan-Hao; Huang, Ting‐Huan; Chang, Ching‐Yi; Liang, Der‐Cherng

doi:10.1200/jco.2013.54.5020

Cited by 39 publications

(47 citation statements)

References 28 publications

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“…Such a systematic change may have slightly changed the incidence pattern of childhood cancer. Future validation with an external data source, such as a nongovernment organization or a cooperative study group with an independent database [34][35][36], can further help to confirm the incidence-trend of childhood cancers.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of cancer in children aged 0–14 years in Taiwan, 1996–2010

Liu

Chiang

et al. 2015

Cancer Epidemiology

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Section: Discussionmentioning

confidence: 99%

“…cancer risks and treatment outcome, which direct future studies on individual cancer types. Whether new therapeutic regimens improve the patient survival and outcome will be best answered through cooperative clinical protocols [34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Incidence of cancer in children aged 0–14 years in Taiwan, 1996–2010

Liu

Chiang

et al. 2015

Cancer Epidemiology

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“…Two reports have shown that delayed lumbar puncture reduced the iatrogenic invasion of the CNS and contributed to minimize the proportion of cases requiring intensified CNS therapy without compromising the outcome. In the TCCSG trials, the first IT was delayed at day 8, and the Taiwan Pediatric Oncology Group (TPOG) postponed the first IT until the disappearance of blasts from the peripheral blood at day 10 . Optimal timing of the first IT, however, is yet to be determined.…”

Section: Treatmentmentioning

confidence: 99%

Treatment and biology of pediatric acute lymphoblastic leukemia

Kato

Manabe

2018

Pediatrics International

212

175

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Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. In the past ALL was intractable but now the survival probability is as high as 80-90%. Improved supportive care, treatment stratification based on relapse risk, biological features of leukemic cells, and optimization of treatment regimens by nationwide and international collaboration have contributed to this dramatic improvement. While including traditional risk factors (e.g. age and leukocyte count at diagnosis), the treatment has been modified based on biological characteristics (aneuploidy and translocation) and treatment response (assessed by minimal residual disease). Treatment for pediatric ALL typically consists of induction therapy with steroids, vincristine, and asparaginase with or without anthracycline, followed by multi-agent consolidation including high-dose methotrexate and re-induction therapy. After consolidation, less intensive maintenance therapy is required for 1-2 years to maintain event-free survival. Recently, using advanced genomic analysis technology, novel sentinel genomic alterations that may provide more precise stratification or therapeutic targets, were identified. Moreover, in the last decade germline variations have been recognized as similarly important contributors to understanding the etiology and sensitivity of ALL to treatment. A more individualized approach based on genomic features (somatic and germline) and treatment response, the introduction of newly developed agents such as molecular targeted drugs or immunotherapy, and social support including long-term follow up are required for further improvement.Key words acute lymphoblastic leukemia, biology, clinical trial, treatment.Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy and is newly diagnosed in approximately 500 children in Japan annually. A slight male predominance (approx. 1.2-fold higher in boys) has been observed, with a peak incidence at 1-4 years of age. 1 Survival rates were poor 50 years ago, and leukemia was considered to be an intractable disease. Most recent clinical trials, however, have achieved an overall survival probability of 80-90%. The main contributors to this dramatic improvement are the availability of better supportive care, treatment stratification based on relapse risk and the biological features of leukemic cells, and the accumulation of evidence uncovered by clinical trials through nationwide and international collaboration. We herein review the history, current status, and future prospects for the treatment of pediatric ALL, focusing on interventions and biology while excluding infant ALL and relapsed ALL, which have been reported on elsewhere. 2,3

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“…Recently the complete abandonment of cranial irradiation has been incorporated into frontline trials even for patients with overt CNS disease at diagnosis (47, 48). Pui showed that by augmenting systemic therapy, using triple IT therapy, reducing traumatic lumbar punctures (associated with contamination of the CNS with peripheral blood blasts), and using risk stratified therapy that included minimal residual disease testing achieved a superior 5 year EFS (93.5%) with only 2.7% of patients suffering a CNS relapse (47).…”

Section: Optimizing Cns Therapy To Prevent Neurocognitive Toxicitymentioning

confidence: 99%

Therapies on the horizon for childhood acute lymphoblastic leukemia

Carroll

Hunger

2016

Current Opinion in Pediatrics

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Purpose of the review The prognosis for children with the most common childhood malignancy, acute lymphoblastic leukemia (ALL) has improved dramatically. However the burden of therapy can be substantial with long term side effects and certain subgroups continue to have a poor outcome. Recent Advances The recent discovery of new genetic alterations in high risk subsets provide targets for precision medicine-based interventions using existing FDA approved agents. Novel immunotherapeutic approaches are being deployed in relapsed ALL, one of the leading causes of cancer cell death in children. Moreover genomic analysis has charted the evolution of tumor subclones and relapse specific alterations now provide a mechanistic explanation for drug resistance setting the stage for targeted therapy. There is greater recognition that host factors, genetic polymorphisms, influence cancer risk, response to therapy and toxicity. In the future it is anticipated that they will be integrated into clinical decision making to maximize cure and minimize side effects. Recent efforts to limit prophylactic central nervous system irradiation have been successful thereby sparing many children late neurocognitive impairments. Summary Integration of advances in precision medicine approaches and novel agents will continue to increase the cure rate and decrease the burden of therapy for childhood ALL.

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Triple Intrathecal Therapy Alone With Omission of Cranial Radiation in Children With Acute Lymphoblastic Leukemia

Abstract: Delaying first TIT until circulating blasts have cleared may improve CNS control in children with newly diagnosed ALL and preclude the need for CrRT.

Cited by 39 publications

References 28 publications

Incidence of cancer in children aged 0–14 years in Taiwan, 1996–2010

Incidence of cancer in children aged 0–14 years in Taiwan, 1996–2010

Treatment and biology of pediatric acute lymphoblastic leukemia

Therapies on the horizon for childhood acute lymphoblastic leukemia

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