TY - JOUR
T1 - Teniposide plus cytarabine improves outcome in childhood acute lymphoblastic leukemia presenting with a leukocyte count ≥ 100 x 109/L
AU - Dahl, G. V.
AU - Rivera, G. K.
AU - Look, A. T.
AU - Hustu, H. O.
AU - Kalwinsky, D. K.
AU - Abromowitch, M.
AU - Mirro, J.
AU - Ochs, J.
AU - Murphy, S. B.
AU - Dodge, R. K.
AU - Ching-Hon Pui, Pui
PY - 1987
Y1 - 1987
N2 - Childhood acute lymphoblastic leukemia with a initial leukocyte count ≥ 100 x 109/L responds poorly to conventional chemotherapy. To extend event-free survival (EFS) in this disease, we devised a protocol that specifies intensive 2-week courses of teniposide (VM-26, 165 mg/m2) plus cytarabine (ara-C, 300 mg/m2), before and immediately after standard 4-week remission induction therapy with prednisone, vincristine, and L-asparaginase. The VM-26 and ara-C combination was also administered intermittently for the first year of continuation treatment with oral 6-mercaptopurine and methotrexate. CNS prophylaxis consisted of periodic intrathecal (IT) injections of methotrexate and delayed cranial irradiation. At a median follow-up of 4 years, the estimated EFS rate for 57 consecutive patients with leukocyte counts of 100 to 1,000 x 109/L was 44%, compared with 10% for matched controls (P < .001). Remission induction rates in the two groups were similar (82% v 72%, P = .16). Twenty-five patients in the VM-26/ara-C group have survived without adverse events for 2.7 to 6.8 years, whereas only nine of the controls achieved more than a year of EFS. The most common complications during early treatment were acute hyperkalemia from rapid tumor cell lysis and infections due to prolonged marrow aplasia. Continuation chemotherapy was well tolerated. We conclude that VM-26 plus ara-C, added to each phase of an otherwise basic regimen of chemotherapy, will substantially improve prognosis in this high-risk form of childhood leukemia.
AB - Childhood acute lymphoblastic leukemia with a initial leukocyte count ≥ 100 x 109/L responds poorly to conventional chemotherapy. To extend event-free survival (EFS) in this disease, we devised a protocol that specifies intensive 2-week courses of teniposide (VM-26, 165 mg/m2) plus cytarabine (ara-C, 300 mg/m2), before and immediately after standard 4-week remission induction therapy with prednisone, vincristine, and L-asparaginase. The VM-26 and ara-C combination was also administered intermittently for the first year of continuation treatment with oral 6-mercaptopurine and methotrexate. CNS prophylaxis consisted of periodic intrathecal (IT) injections of methotrexate and delayed cranial irradiation. At a median follow-up of 4 years, the estimated EFS rate for 57 consecutive patients with leukocyte counts of 100 to 1,000 x 109/L was 44%, compared with 10% for matched controls (P < .001). Remission induction rates in the two groups were similar (82% v 72%, P = .16). Twenty-five patients in the VM-26/ara-C group have survived without adverse events for 2.7 to 6.8 years, whereas only nine of the controls achieved more than a year of EFS. The most common complications during early treatment were acute hyperkalemia from rapid tumor cell lysis and infections due to prolonged marrow aplasia. Continuation chemotherapy was well tolerated. We conclude that VM-26 plus ara-C, added to each phase of an otherwise basic regimen of chemotherapy, will substantially improve prognosis in this high-risk form of childhood leukemia.
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U2 - 10.1200/JCO.1987.5.7.1015
DO - 10.1200/JCO.1987.5.7.1015
M3 - Article
C2 - 3474355
AN - SCOPUS:0023551240
SN - 0732-183X
VL - 5
SP - 1015
EP - 1021
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 7
ER -