Cyclic combination chemotherapy for acute lymphoblastic leukemia recurring after elective cessation of therapy

Ching‐Hon ‐H Pui, Paul Bowman, Judith Ochs, Richard K. Dodge, Gaston K. Rivera

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Cyclic combination chemotherapy was administered to 26 patients with acute lymphoblastic leukemia who had relapsed in the bone marrow ≥ 6 months after elective cessation of therapy. Each patient had been in initial continuous complete remission for 36‐111 months (median, 47 months). Prednisone, vincristine, and doxorubicin induced second complete remissions in all patients within 1 month. Continuation therapy consisted of alternating 6‐week courses of 6‐mercaptopurine/methotrexate and vincristine/cyclo‐phosphamide with intervening reinforcement courses of prednisone/doxorubicin, for a total of 18 months. All patients received 4 weeks of late intensification therapy with the same agents used for remission reinduction. Periodic intrathecal methotrexate was given as reprophylaxis for subclinical central nervous system leukemia. The estimated rate of continuous failure‐free survival at 5 years is 31% ± 17% (2 SE). Eight patients remain free of leukemia for 42+ to 65+ months after completing therapy a second time. Adverse second events included 11 hematologic, 1 testicular, and 3 meningeal relapses. Patients who relapsed at more than 12 months after the completion of initial treatment have had significantly longer second remissions than patients whose first remissions were shorter (p = .04). None of the other six factors we analyzed showed predictive strength. These end results indicate that intensive cyclic continuation chemotherapy, as described here, will secure durable second remissions in approximately one‐third of the children with late bone marrow relapses.

Original languageEnglish
Pages (from-to)21-26
Number of pages6
JournalMedical and Pediatric Oncology
Volume16
Issue number1
DOIs
StatePublished - 1 Jan 1988

Fingerprint

Combination Drug Therapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Vincristine
Prednisone
Methotrexate
Doxorubicin
Therapeutics
Leukemia
Bone Marrow
Recurrence
Cyclophosphamide
Central Nervous System
Drug Therapy
Survival

Keywords

  • antileukemic agents
  • continuation therapy
  • off‐therapy relapses
  • remission reinduction

Cite this

Pui, Ching‐Hon ‐H ; Bowman, Paul ; Ochs, Judith ; Dodge, Richard K. ; Rivera, Gaston K. / Cyclic combination chemotherapy for acute lymphoblastic leukemia recurring after elective cessation of therapy. In: Medical and Pediatric Oncology. 1988 ; Vol. 16, No. 1. pp. 21-26.
@article{8139fe5cbad642b0a7a7e06467721622,
title = "Cyclic combination chemotherapy for acute lymphoblastic leukemia recurring after elective cessation of therapy",
abstract = "Cyclic combination chemotherapy was administered to 26 patients with acute lymphoblastic leukemia who had relapsed in the bone marrow ≥ 6 months after elective cessation of therapy. Each patient had been in initial continuous complete remission for 36‐111 months (median, 47 months). Prednisone, vincristine, and doxorubicin induced second complete remissions in all patients within 1 month. Continuation therapy consisted of alternating 6‐week courses of 6‐mercaptopurine/methotrexate and vincristine/cyclo‐phosphamide with intervening reinforcement courses of prednisone/doxorubicin, for a total of 18 months. All patients received 4 weeks of late intensification therapy with the same agents used for remission reinduction. Periodic intrathecal methotrexate was given as reprophylaxis for subclinical central nervous system leukemia. The estimated rate of continuous failure‐free survival at 5 years is 31{\%} ± 17{\%} (2 SE). Eight patients remain free of leukemia for 42+ to 65+ months after completing therapy a second time. Adverse second events included 11 hematologic, 1 testicular, and 3 meningeal relapses. Patients who relapsed at more than 12 months after the completion of initial treatment have had significantly longer second remissions than patients whose first remissions were shorter (p = .04). None of the other six factors we analyzed showed predictive strength. These end results indicate that intensive cyclic continuation chemotherapy, as described here, will secure durable second remissions in approximately one‐third of the children with late bone marrow relapses.",
keywords = "antileukemic agents, continuation therapy, off‐therapy relapses, remission reinduction",
author = "Pui, {Ching‐Hon ‐H} and Paul Bowman and Judith Ochs and Dodge, {Richard K.} and Rivera, {Gaston K.}",
year = "1988",
month = "1",
day = "1",
doi = "10.1002/mpo.2950160106",
language = "English",
volume = "16",
pages = "21--26",
journal = "Medical and Pediatric Oncology",
issn = "0098-1532",
publisher = "John Wiley and Sons Inc.",
number = "1",

}

Cyclic combination chemotherapy for acute lymphoblastic leukemia recurring after elective cessation of therapy. / Pui, Ching‐Hon ‐H; Bowman, Paul; Ochs, Judith; Dodge, Richard K.; Rivera, Gaston K.

In: Medical and Pediatric Oncology, Vol. 16, No. 1, 01.01.1988, p. 21-26.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cyclic combination chemotherapy for acute lymphoblastic leukemia recurring after elective cessation of therapy

AU - Pui, Ching‐Hon ‐H

AU - Bowman, Paul

AU - Ochs, Judith

AU - Dodge, Richard K.

AU - Rivera, Gaston K.

PY - 1988/1/1

Y1 - 1988/1/1

N2 - Cyclic combination chemotherapy was administered to 26 patients with acute lymphoblastic leukemia who had relapsed in the bone marrow ≥ 6 months after elective cessation of therapy. Each patient had been in initial continuous complete remission for 36‐111 months (median, 47 months). Prednisone, vincristine, and doxorubicin induced second complete remissions in all patients within 1 month. Continuation therapy consisted of alternating 6‐week courses of 6‐mercaptopurine/methotrexate and vincristine/cyclo‐phosphamide with intervening reinforcement courses of prednisone/doxorubicin, for a total of 18 months. All patients received 4 weeks of late intensification therapy with the same agents used for remission reinduction. Periodic intrathecal methotrexate was given as reprophylaxis for subclinical central nervous system leukemia. The estimated rate of continuous failure‐free survival at 5 years is 31% ± 17% (2 SE). Eight patients remain free of leukemia for 42+ to 65+ months after completing therapy a second time. Adverse second events included 11 hematologic, 1 testicular, and 3 meningeal relapses. Patients who relapsed at more than 12 months after the completion of initial treatment have had significantly longer second remissions than patients whose first remissions were shorter (p = .04). None of the other six factors we analyzed showed predictive strength. These end results indicate that intensive cyclic continuation chemotherapy, as described here, will secure durable second remissions in approximately one‐third of the children with late bone marrow relapses.

AB - Cyclic combination chemotherapy was administered to 26 patients with acute lymphoblastic leukemia who had relapsed in the bone marrow ≥ 6 months after elective cessation of therapy. Each patient had been in initial continuous complete remission for 36‐111 months (median, 47 months). Prednisone, vincristine, and doxorubicin induced second complete remissions in all patients within 1 month. Continuation therapy consisted of alternating 6‐week courses of 6‐mercaptopurine/methotrexate and vincristine/cyclo‐phosphamide with intervening reinforcement courses of prednisone/doxorubicin, for a total of 18 months. All patients received 4 weeks of late intensification therapy with the same agents used for remission reinduction. Periodic intrathecal methotrexate was given as reprophylaxis for subclinical central nervous system leukemia. The estimated rate of continuous failure‐free survival at 5 years is 31% ± 17% (2 SE). Eight patients remain free of leukemia for 42+ to 65+ months after completing therapy a second time. Adverse second events included 11 hematologic, 1 testicular, and 3 meningeal relapses. Patients who relapsed at more than 12 months after the completion of initial treatment have had significantly longer second remissions than patients whose first remissions were shorter (p = .04). None of the other six factors we analyzed showed predictive strength. These end results indicate that intensive cyclic continuation chemotherapy, as described here, will secure durable second remissions in approximately one‐third of the children with late bone marrow relapses.

KW - antileukemic agents

KW - continuation therapy

KW - off‐therapy relapses

KW - remission reinduction

UR - http://www.scopus.com/inward/record.url?scp=0023857365&partnerID=8YFLogxK

U2 - 10.1002/mpo.2950160106

DO - 10.1002/mpo.2950160106

M3 - Article

C2 - 3422333

AN - SCOPUS:0023857365

VL - 16

SP - 21

EP - 26

JO - Medical and Pediatric Oncology

JF - Medical and Pediatric Oncology

SN - 0098-1532

IS - 1

ER -