Impact of three methods of treatment intensification on acute lymphoblastic leukemia in children: Long-term results of St Jude total therapy study X

Ching Hon Pui, Joseph V. Simone, Michael L. Hancock, William E. Evans, Dorothy L. Williams, W. Paul Bowman, Gary V. Dahl, Richard K. Dodge, Judith Ochs, Minnie Abromowitch, Gaston K. Rivera

Research output: Contribution to journalArticle

65 Scopus citations

Abstract

Long-term follow-up observations are reported on 427 patients who received one of three different intensified therapies in total therapy study X for acute lymphoblastic leukemia (ALL). In the trial for 'standard-risk' ALL, 154 of 309 patients in complete remission were randomized to receive high-dose methotrexate (HDMTX, 1 g/m2) periodically during the first 72 of 120 weeks of standard continuation therapy with 6-mercaptopurine and oral MTX; the remaining 155 patients received 1800 cGy cranial irradiation and intrathecal MTX, followed by 6-mercaptopurine/MTX therapy interrupted from week 36-71 for substitution of two other pairs of drugs. At 9 years of follow-up, significantly higher proportions of patients in the HDMTX group have maintained complete remissions (64 ± 7%, SE, vs. 52 ± 6%, p = 0.03), hematologic remissions (73 ± 6% vs. 62 ± 6%, p = 0.03), and testicular remissions (94 ± 5% vs. 80 ± 8%, p = 0.03); however, the proportion continuing in central nervous system remission has been lower (84 ± 5% vs 93 ± 4%, p = 0.02). In the evaluation of teniposide cytarabine and delayed cranial irradiation for 'high-risk' ALL, 36 ± 9% of 101 patients are predicted to be event-free survivors at 9 years. Altogether, 217 (51%) of the 427 patients are event-free survivors after at least 7 years of follow-up (median, 9 years); an additional 75 patients are alive and free of leukemia for a median of 6.4 years after successful remission retrieval therapy, boosting the total number of long-term survivors to 292 (68%). These results establish the efficacy of HDMTX for patients with standard-risk ALL and indicate the potential of teniposide cytarabine for use in multiagent regimens for patients with high-risk disease. The overall survival figure, 68%, affords a benchmark for other studies assessing long-term outcome in ALL.

Original languageEnglish (US)
Pages (from-to)150-157
Number of pages8
JournalLeukemia
Volume6
Issue number2
StatePublished - Feb 1992

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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    Pui, C. H., Simone, J. V., Hancock, M. L., Evans, W. E., Williams, D. L., Bowman, W. P., Dahl, G. V., Dodge, R. K., Ochs, J., Abromowitch, M., & Rivera, G. K. (1992). Impact of three methods of treatment intensification on acute lymphoblastic leukemia in children: Long-term results of St Jude total therapy study X. Leukemia, 6(2), 150-157.