Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy

G. K. Rivera; C. H. Pui; M. Abromowitch; J. Mirro; J. S. Ochs; A. T. Look; S. B. Murphy; G. V. Dahl; D. K. Kalwinsky; J. V. Simone; W. M. Crist; S. C. Raimondi; F. G. Behm; D. L. Williams; M. L. Hancock; W. E. Evans; L. E. Kun

doi:10.1016/0140-6736(91)90733-6

Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy

G. K. Rivera, C. H. Pui, M. Abromowitch, J. Mirro, J. S. Ochs, A. T. Look, S. B. Murphy, G. V. Dahl, D. K. Kalwinsky, J. V. Simone, W. M. Crist, S. C. Raimondi, F. G. Behm, D. L. Williams, M. L. Hancock, W. E. Evans, L. E. Kun

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Abstract

To improve outcome in childhood acute lymphoblastic leukaemia (ALL), a stratified, randomised study of extended intensified chemotherapy was done. 358 evaluable patients received remission reinforcement therapy (teniposide, cytarabine, high-dose methotrexate) added to a four-drug induction regimen. Those achieving complete remission were randomised on the basis of risk group assignment to conventional continuation treatment or to four pairs of drugs rotated weekly or every 6 weeks. All patients received intrathecal chemotherapy; higher-risk patients also received 1800 cGy cranial irradiation after 1 year of remission. Complete remission was induced in 96% of the patients. At median follow-up of 40 (range 19-73) months, 4-year event-free survival (SE) was 73 (4)% overall, 81 (6)% in the lower-risk group (n=110), and 69 (5)% in the higher-risk group (n=248). Outcome within risk groups was not significantly affected by the speed of rotation of drug pairs during continuation treatment. Various highrisk subgroups had apparently improved responses to this treatment. This intensified chemotherapy may cure 69-77% of children with ALL.

Original language	English (US)
Pages (from-to)	61-66
Number of pages	6
Journal	The Lancet
Volume	337
Issue number	8733
DOIs	https://doi.org/10.1016/0140-6736(91)90733-6
State	Published - Jan 12 1991
Externally published	Yes

ASJC Scopus subject areas

General Medicine

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Rivera, G. K., Pui, C. H., Abromowitch, M., Mirro, J., Ochs, J. S., Look, A. T., Murphy, S. B., Dahl, G. V., Kalwinsky, D. K., Simone, J. V., Crist, W. M., Raimondi, S. C., Behm, F. G., Williams, D. L., Hancock, M. L., Evans, W. E., & Kun, L. E. (1991). Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy. The Lancet, 337(8733), 61-66. https://doi.org/10.1016/0140-6736(91)90733-6

Rivera, GK, Pui, CH, Abromowitch, M, Mirro, J, Ochs, JS, Look, AT, Murphy, SB, Dahl, GV, Kalwinsky, DK, Simone, JV, Crist, WM, Raimondi, SC, Behm, FG, Williams, DL, Hancock, ML, Evans, WE & Kun, LE 1991, 'Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy', The Lancet, vol. 337, no. 8733, pp. 61-66. https://doi.org/10.1016/0140-6736(91)90733-6

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title = "Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy",

abstract = "To improve outcome in childhood acute lymphoblastic leukaemia (ALL), a stratified, randomised study of extended intensified chemotherapy was done. 358 evaluable patients received remission reinforcement therapy (teniposide, cytarabine, high-dose methotrexate) added to a four-drug induction regimen. Those achieving complete remission were randomised on the basis of risk group assignment to conventional continuation treatment or to four pairs of drugs rotated weekly or every 6 weeks. All patients received intrathecal chemotherapy; higher-risk patients also received 1800 cGy cranial irradiation after 1 year of remission. Complete remission was induced in 96% of the patients. At median follow-up of 40 (range 19-73) months, 4-year event-free survival (SE) was 73 (4)% overall, 81 (6)% in the lower-risk group (n=110), and 69 (5)% in the higher-risk group (n=248). Outcome within risk groups was not significantly affected by the speed of rotation of drug pairs during continuation treatment. Various highrisk subgroups had apparently improved responses to this treatment. This intensified chemotherapy may cure 69-77% of children with ALL.",

author = "Rivera, {G. K.} and Pui, {C. H.} and M. Abromowitch and J. Mirro and Ochs, {J. S.} and Look, {A. T.} and Murphy, {S. B.} and Dahl, {G. V.} and Kalwinsky, {D. K.} and Simone, {J. V.} and Crist, {W. M.} and Raimondi, {S. C.} and Behm, {F. G.} and Williams, {D. L.} and Hancock, {M. L.} and Evans, {W. E.} and Kun, {L. E.}",

note = "Funding Information: This study was supported by grants (CA 20180 and CA 21765) from the National Cancer Institute and the American Lebanese Syrian Associated Charities (ALSAC).",

year = "1991",

month = jan,

day = "12",

doi = "10.1016/0140-6736(91)90733-6",

language = "English (US)",

volume = "337",

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T1 - Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy

AU - Rivera, G. K.

AU - Pui, C. H.

AU - Abromowitch, M.

AU - Mirro, J.

AU - Ochs, J. S.

AU - Look, A. T.

AU - Murphy, S. B.

AU - Dahl, G. V.

AU - Kalwinsky, D. K.

AU - Simone, J. V.

AU - Crist, W. M.

AU - Raimondi, S. C.

AU - Behm, F. G.

AU - Williams, D. L.

AU - Hancock, M. L.

AU - Evans, W. E.

AU - Kun, L. E.

N1 - Funding Information: This study was supported by grants (CA 20180 and CA 21765) from the National Cancer Institute and the American Lebanese Syrian Associated Charities (ALSAC).

PY - 1991/1/12

Y1 - 1991/1/12

N2 - To improve outcome in childhood acute lymphoblastic leukaemia (ALL), a stratified, randomised study of extended intensified chemotherapy was done. 358 evaluable patients received remission reinforcement therapy (teniposide, cytarabine, high-dose methotrexate) added to a four-drug induction regimen. Those achieving complete remission were randomised on the basis of risk group assignment to conventional continuation treatment or to four pairs of drugs rotated weekly or every 6 weeks. All patients received intrathecal chemotherapy; higher-risk patients also received 1800 cGy cranial irradiation after 1 year of remission. Complete remission was induced in 96% of the patients. At median follow-up of 40 (range 19-73) months, 4-year event-free survival (SE) was 73 (4)% overall, 81 (6)% in the lower-risk group (n=110), and 69 (5)% in the higher-risk group (n=248). Outcome within risk groups was not significantly affected by the speed of rotation of drug pairs during continuation treatment. Various highrisk subgroups had apparently improved responses to this treatment. This intensified chemotherapy may cure 69-77% of children with ALL.

AB - To improve outcome in childhood acute lymphoblastic leukaemia (ALL), a stratified, randomised study of extended intensified chemotherapy was done. 358 evaluable patients received remission reinforcement therapy (teniposide, cytarabine, high-dose methotrexate) added to a four-drug induction regimen. Those achieving complete remission were randomised on the basis of risk group assignment to conventional continuation treatment or to four pairs of drugs rotated weekly or every 6 weeks. All patients received intrathecal chemotherapy; higher-risk patients also received 1800 cGy cranial irradiation after 1 year of remission. Complete remission was induced in 96% of the patients. At median follow-up of 40 (range 19-73) months, 4-year event-free survival (SE) was 73 (4)% overall, 81 (6)% in the lower-risk group (n=110), and 69 (5)% in the higher-risk group (n=248). Outcome within risk groups was not significantly affected by the speed of rotation of drug pairs during continuation treatment. Various highrisk subgroups had apparently improved responses to this treatment. This intensified chemotherapy may cure 69-77% of children with ALL.

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ER -

Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy

Abstract

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