TY - JOUR
T1 - Therapeutic trial for infant acute lymphoblastic leukemia
T2 - The pediatric oncology group experience (POG 8493)
AU - Frankel, Lawrence S.
AU - Ochs, J.
AU - Shuster, J. J.
AU - Dubowy, R.
AU - Bowman, W. P.
AU - Hockenberry-Eaton, M.
AU - Borowitz, M.
AU - Carroll, A. J.
AU - Steuber, C. P.
AU - Pullen, D. J.
PY - 1997
Y1 - 1997
N2 - Purpose: Despite improved event-free survival of older children with acute lymphocytic leukemia (ALL), infants <1 year of age continue to have a very poor prognosis. A new therapy designed specifically for infants with ALL was initiated. Patients and Methods: From 1984 until 1990, 82 eligible infants <1 year of age were entered on a Pediatric Oncology Group (POG) protocol 8493 for infant ALL. Compared to older patients, infants at diagnosis had more overt CNS leukemia (26%), higher initial WBC count (56%>50,000/µl), and a higher likelihood of CD-10 (CALLA) negative lymphoblasts (55%). A translocation involving chromosome 11 at band q23 was detected in 27 of 64 cytogenetically informative cases. Treatment was based upon two institutional pilot studies utilizing chemotherapy doses based upon body weight. Important components included remission induction with cyclophosphamide (Ctx), vincristine (Vcr), cytosine arabinoside (Ara-C), and prednisone (Pred) (COAP); consolidation therapy with teniposide (VM-26) and Ara-C; and continuation therapy with alternating pulses of COAP with VM-26/Ara-C separated by a methotrexate (Mtx) and 6-mercaptopurine (6-MP) backbone plus CNS therapy consisting of standard triple intrathecal therapy (TIT) (Mtx/hydrocortisone/Arc-C), which avoided the use of radiotherapy in this population. Results: Seventy-six infants achieved a complete remission (93%). Fifty patients have relapsed: 35 isolated marrow relapses, five isolated CNS relapses, eight combined marrow and CNS relapses, and two other relapses. Actuarial event-free survival was 28% (SE=5%) at 4 years. Infants >274 days (9 months) at diagnosis had a better outcome than those <274 days. Conclusions: This study represents a modest outcome improvement in comparison to previous experience with ALL for infants treated on POG trials. More effective therapy is still needed for infants with ALL.
AB - Purpose: Despite improved event-free survival of older children with acute lymphocytic leukemia (ALL), infants <1 year of age continue to have a very poor prognosis. A new therapy designed specifically for infants with ALL was initiated. Patients and Methods: From 1984 until 1990, 82 eligible infants <1 year of age were entered on a Pediatric Oncology Group (POG) protocol 8493 for infant ALL. Compared to older patients, infants at diagnosis had more overt CNS leukemia (26%), higher initial WBC count (56%>50,000/µl), and a higher likelihood of CD-10 (CALLA) negative lymphoblasts (55%). A translocation involving chromosome 11 at band q23 was detected in 27 of 64 cytogenetically informative cases. Treatment was based upon two institutional pilot studies utilizing chemotherapy doses based upon body weight. Important components included remission induction with cyclophosphamide (Ctx), vincristine (Vcr), cytosine arabinoside (Ara-C), and prednisone (Pred) (COAP); consolidation therapy with teniposide (VM-26) and Ara-C; and continuation therapy with alternating pulses of COAP with VM-26/Ara-C separated by a methotrexate (Mtx) and 6-mercaptopurine (6-MP) backbone plus CNS therapy consisting of standard triple intrathecal therapy (TIT) (Mtx/hydrocortisone/Arc-C), which avoided the use of radiotherapy in this population. Results: Seventy-six infants achieved a complete remission (93%). Fifty patients have relapsed: 35 isolated marrow relapses, five isolated CNS relapses, eight combined marrow and CNS relapses, and two other relapses. Actuarial event-free survival was 28% (SE=5%) at 4 years. Infants >274 days (9 months) at diagnosis had a better outcome than those <274 days. Conclusions: This study represents a modest outcome improvement in comparison to previous experience with ALL for infants treated on POG trials. More effective therapy is still needed for infants with ALL.
KW - Acute lymphocytic leukemia of childhood
KW - Infant leukemia
KW - Therapy of leukemia in infants
UR - http://www.scopus.com/inward/record.url?scp=0031003109&partnerID=8YFLogxK
U2 - 10.1097/00043426-199701000-00005
DO - 10.1097/00043426-199701000-00005
M3 - Article
C2 - 9065717
AN - SCOPUS:0031003109
SN - 0192-8562
VL - 19
SP - 35
EP - 42
JO - American Journal of Pediatric Hematology/Oncology
JF - American Journal of Pediatric Hematology/Oncology
IS - 1
ER -