In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 28, No. 14 ( 2010-05-10), p. 2339-2347
Abstract:
The multicenter trial ALL-REZ BFM (ie, Acute Lymphoblastic Leukemia Relapse Berlin-Frankfurt-Münster) 90 was designed to improve prognosis for children with relapsed acute lymphoblastic leukemia (ALL) by time-to-relapse– and site-of-relapse–adapted stratification and by introduction of novel chemotherapy elements and to evaluate new prognostic parameters in a large, population-based cohort. Patients and Methods Five hundred twenty-five patients stratified into risk groups A (early bone marrow [BM] relapses), B (late BM relapses), and C (isolated extramedullary relapses) received alternating short-course intensive polychemotherapy (in blocks R1, R2, or R3) and cranial/craniospinal irradiation followed by maintenance therapy. Block R3 (high-dose cytarabine and etoposide) was introduced to improve the outcome compared with historical controls. Patients with early BM or T-ALL relapse (poor prognosis group [PPG] ) were eligible for experimental regimens. One hundred seventeen patients received stem-cell transplantation (SCT). Results The probabilities (and standard deviations) of event-free survival (pEFS) and overall survival (pOS) at 10 years were 0.30 ± .02 and 0.36 ± .02, respectively. Significant differences existed between strategic groups (pEFS A = .17 ± .03; pEFS B = .43 ± .04; pEFS C = .54 ± .06; pEFS PPG = .15 ± .03; log-rank P 〈 .001). Patients of high-risk groups A plus PPG did better with SCT than with chemotherapy (pEFS = .33 ± .05 v 0.20 ± .05; P = .005). The pEFS was similar to trials ALL-REZ BFM 85/87 (.36 ± .03. v 0.37 ± .03; P = .419; PPG excluded). Time point, site of relapse, immunophenotype, and SCT were significant predictors of pEFS in multivariate analyses. Conclusion More than one third of patients in this large, population-based trial were cured. Neither R3 nor adaptation of chemotherapy intensity was capable of improving pEFS or of overcoming prognostic factors. In high-risk patients, remission induction regimens must be improved, and allogeneic SCT should be recommended in patients achieving second complete remission.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/JCO.2009.25.1983
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2010
detail.hit.zdb_id:
2005181-5
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