Improvement in CNS protective treatment in non-high-risk childhood acute lymphoblastic leukemia: report from the Japanese Children's Cancer and Leukemia Study Group
1999; Alan R. Liss, Inc.; Volume: 32; Issue: 4 Linguagem: Inglês
10.1002/(sici)1096-911x(199904)32
ISSN1096-911X
AutoresMasahito Tsurusawa, N Katano, Yoshifumi Yamamoto, T Hirota, S Koizumi, Arata Watanabe, Takeo Takeda, Y Hatae, M Yatabe, J Mimaya, T Gushiken, Kunihiro Nishi, Kenichi Anami, Atsushi Kikuta, Hirokazu Kanegane, Keiko Asami, K Nishikawa, Isao Sekine, Yoshifumi Kawano, Asayuki Iwai, Teruhisa Furuyama, Osamu Ijichi, Munenori Miyake, Hideo Mugishima, Shigeru Ota, Takeo Fujimoto,
Tópico(s)Lung Cancer Research Studies
ResumoMedical and Pediatric OncologyVolume 32, Issue 4 p. 259-266 Improvement in CNS protective treatment in non–high-risk childhood acute lymphoblastic leukemia: report from the Japanese Children's Cancer and Leukemia Study Group Masahito Tsurusawa MD, Corresponding Author Masahito Tsurusawa MD [email protected] Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanDepartment of Pediatrics, Aichi Medical University, Nagakute, Aichi, 480-1195, JapanSearch for more papers by this authorNaoyuki Katano MD, Naoyuki Katano MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorYoshifumi Yamamoto MD, Yoshifumi Yamamoto MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorTakahisa Hirota MD, Takahisa Hirota MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorSyoichi Koizumi MD, Syoichi Koizumi MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorArata Watanabe MD, Arata Watanabe MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorTakeo Takeda MD, Takeo Takeda MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorYosirou Hatae MD, Yosirou Hatae MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorMichio Yatabe MD, Michio Yatabe MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorJunichi Mimaya MD, Junichi Mimaya MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorToshiki Gushiken MD, Toshiki Gushiken MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorKunihiro Nishi MD, Kunihiro Nishi MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorKenichi Anami MD, Kenichi Anami MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorAtsushi Kikuta MD, Atsushi Kikuta MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorHirokazu Kanegane MD, Hirokazu Kanegane MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorKeiko Asami MD, Keiko Asami MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorKenichi Nishikawa MD, Kenichi Nishikawa MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorIsao Sekine MD, Isao Sekine MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorYoshifumi Kawano MD, Yoshifumi Kawano MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorAsayuki Iwai MD, Asayuki Iwai MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorTeruhisa Furuyama MD, Teruhisa Furuyama MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorOsamu Ijichi MD, Osamu Ijichi MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorMunenori Miyake MD, Munenori Miyake MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorHideo Mugishima MD, Hideo Mugishima MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorShigeru Ota MD, Shigeru Ota MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorTakeo Fujimoto MD, Takeo Fujimoto MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this author Masahito Tsurusawa MD, Corresponding Author Masahito Tsurusawa MD [email protected] Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanDepartment of Pediatrics, Aichi Medical University, Nagakute, Aichi, 480-1195, JapanSearch for more papers by this authorNaoyuki Katano MD, Naoyuki Katano MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorYoshifumi Yamamoto MD, Yoshifumi Yamamoto MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorTakahisa Hirota MD, Takahisa Hirota MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorSyoichi Koizumi MD, Syoichi Koizumi MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorArata Watanabe MD, Arata Watanabe MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorTakeo Takeda MD, Takeo Takeda MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorYosirou Hatae MD, Yosirou Hatae MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorMichio Yatabe MD, Michio Yatabe MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorJunichi Mimaya MD, Junichi Mimaya MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorToshiki Gushiken MD, Toshiki Gushiken MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorKunihiro Nishi MD, Kunihiro Nishi MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorKenichi Anami MD, Kenichi Anami MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorAtsushi Kikuta MD, Atsushi Kikuta MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorHirokazu Kanegane MD, Hirokazu Kanegane MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorKeiko Asami MD, Keiko Asami MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorKenichi Nishikawa MD, Kenichi Nishikawa MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorIsao Sekine MD, Isao Sekine MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorYoshifumi Kawano MD, Yoshifumi Kawano MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorAsayuki Iwai MD, Asayuki Iwai MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorTeruhisa Furuyama MD, Teruhisa Furuyama MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorOsamu Ijichi MD, Osamu Ijichi MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorMunenori Miyake MD, Munenori Miyake MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorHideo Mugishima MD, Hideo Mugishima MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorShigeru Ota MD, Shigeru Ota MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this authorTakeo Fujimoto MD, Takeo Fujimoto MD Department of Pediatrics, Aichi Medical University, Nagakute, Aichi, JapanSearch for more papers by this author First published: 18 March 1999 https://doi.org/10.1002/(SICI)1096-911X(199904)32:4 3.0.CO;2-3Citations: 7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Background Prevention of central nervous system (CNS) leukemia by early introduction of therapy to this sanctuary site is an essential component of modern treatment strategy for acute lymphoblastic leukemia (ALL). However, the optimal form of preventive CNS therapy remains debatable. Procedure To address this issue, we evaluated the efficacy of CNS preventive therapy for 572 children with ALL who achieved complete remission in the Children's Cancer and Leukemia Study Group (CCLSG) ALL874 (1987–1990) and ALL911 (1991–1993) studies. They received risk-directed therapy based on age and leukocyte count. In the ALL 874 study, the non–high-risk (low-risk [LR] + intermediate risk [IR]) patients were randomly assigned to the conventional cranial irradiation (CRT) regimen (L874A and I874A) and the high-dose methotrexate (HDMTX) regimen without CRT (L874B and I874B). The former patients received 18-Gy CRT plus 3 doses of intrathecal (IT) MTX and the latter patients received 3 courses of HDMTX at 2 g/m2 plus 13 doses of ITMTX (L874B) or 4 courses of HDMTX at 4.5 g/m2 plus 1 dose of ITMTX (I874B). Results The 7-year probabilities (± SE) of CNS relapse-free survival were 97.3% ± 2.6% (L874A, n = 41) vs. 90.3% ± 5.3% (L874B, n = 39) (P = 0.25) in the LR patients, and 100% (I874A, n = 55) vs. 78.5% ± 6.5% (I874B, n = 54) (P = 0.002) in the IR patients. The corresponding disease-free survival (DFS) rates were 79.4% ± 6.5% vs. 74.4% ± 7.3% (P = 0.62) in the LR group and 63.3% ± 6.8% vs. 58.3% ± 7.2% (P = 0.66) in the IR group. Thus, the HDMTX regimen could not provide better protection of CNS relapse as compared with the CRT regimen, although their overall efficacy was not significantly different. In the ALL 911 study, intensive systemic chemotherapy with extended i,t, injections of MTX plus cytarabine achieved a high CNS relapse-free survival (98% ± 1.9% at 7 years) and a favorable DFS (85.5% ± 5% at 7 years) in the IR patients. The patients in the high-risk (HR) group in both ALL874 and ALL911 studies received the 18-Gy or 24-Gy CRT with intensive systemic chemotherapy. Their 7-year probabilities of CNS relapse-free survival ranged from 88% to 95%, among which the T-ALL patients had a risk of CNS leukemia, which was 3–4 times higher compared with B-precursor ALL patients. Conclusions These results indicate that long-term intrathecal CNS prophylaxis as well as appropriate systemic therapy for the non–high-risk patients can provide protection against CNS relapse equivalent to that provided by cranial irradiation. Med. Pediatr. Oncol. 32:259–266, 1999. © 1999 Wiley-Liss, Inc. REFERENCES 1 Bleyer WA, Poplack DG. Prophylaxis and treatment of leukemia in the central nervous system and other sanctuaries. Semin Oncol 1985; 12: 131–148. Medline CASPubMedWeb of Science®Google Scholar 2 Steinherz PG. Radiotherapy vs. intrathecal chemotherapy for CNS prophylaxis in childhood ALL. Oncology 1989; 3: 47–53. Medline CASPubMedGoogle Scholar 3 Packer RJ, Meadows AT, Rorke LB, et al. Long-term sequel of cancer treatment on the central nervous system in childhood. Med Pediatr Oncol 1987; 15: 241–253. Medline 10.1002/mpo.2950150505 PubMedWeb of Science®Google Scholar 4 Otis JJ. Neurotoxicity due to central nervous system therapy for childhood leukemia. Am J Pediatr Hematol Oncol 1989; 11: 93–105. Medline 10.1097/00043426-198921000-00019 PubMedWeb of Science®Google Scholar 5 Smibert E, Anderson V, Godbet T, et al. Risk factors for intellectual and educational sequel of cranial irradiation in childhood acute lymphoblastic leukemia. Br J Cancer 1996; 73: 825–830. Medline 10.1038/bjc.1996.145 CASPubMedWeb of Science®Google Scholar 6 Bleyer WA, Sather HN, Nickerson HJ, et al. Monthly pulses of vincristine and prednisone prevent bone marrow and testicular relapse in low-risk childhood acute lymphoblastic leukemia: a report of the CCG-161 study by the children's cancer study group. J Clin Oncol 1991; 9: 1012–1021 Medline 10.1200/JCO.1991.9.6.1012 CASPubMedWeb of Science®Google Scholar 7 Tubergen DG, Gilchrist GS, O'Brien RT, et al. Prevention of CNS disease in intermediate-risk acute lymphoblastic leukemia: comparison of cranial radiation and intrathecal methotrexate and importance of systemic therapy—a children's cancer group report. J Clin Oncol 1993; 11: 520–526. Medline 10.1200/JCO.1993.11.3.520 CASPubMedWeb of Science®Google Scholar 8 Sullivan MP, Chen T, Dyment PG, et al. Equivalence of intrathecal chemotherapy and radiotherapy as central nervous system prophylaxis in children with acute lymphoblastic leukemia: a Pediatric Oncology Group study. Blood 1982; 60: 948–958. Medline CASPubMedWeb of Science®Google Scholar 9 Krance RA, Newman EM, Ravindranath Y, et al. A pilot study of intermediate-dose methotrexate and cytosine arabinoside, “spread-out” or “up-front,” in continuation therapy for childhood non-T, non-B acute lymphoblastic leukemia. Cancer 1991; 67: 550–556. Medline 10.1002/1097-0142(19910201)67:3 3.0.CO;2-# CASPubMedWeb of Science®Google Scholar 10 Pullen J, Boyett J, Shuster J, et al. Extended triple intrathecal chemotherapy trial for prevention of CNS relapse in good-risk and poor-risk patients with B- progenitor acute lymphoblastic leukemia: a pediatric oncology group study. J Clin Oncol 1993; 11: 839–849. Medline 10.1200/JCO.1993.11.5.839 CASPubMedWeb of Science®Google Scholar 11 Pui CH, Simone JV, Hancock ML, et al. Impact of three methods of treatment intensification on acute lymphoblastic leukemia in children: long-term results of St. Jude total therapy X. Leukemia 1992; 6: 150–157. Medline CASPubMedWeb of Science®Google Scholar 12 Rivera GK, Raimondi SC, Hancock ML, et al. Improved outcome in childhood acute lymphoblastic leukemia with reinforced early treatment and rotational combination chemotherapy. Lancet 1991; 337: 61–66. Medline 10.1016/0140-6736(91)90733-6 PubMedWeb of Science®Google Scholar 13 Buhrer C, Henze G, Hofmann J, et al. Central nervous system relapse prevention in 1165 standard-risk children with acute lymphoblastic leukemia in five BFM trials. Hematol Blood Transfus 1990; 33: 500–503. CASGoogle Scholar 14 Reiter A, Schrappe M, Ludwig WF, et al. Chemotherapy in 998 unselected childhood acute lymphoblastic leukemia patients: results and conclusions of the multicenter trial ALL-BFM 86. Blood 1994; 84: 3122–3133. Medline CASPubMedWeb of Science®Google Scholar 15 Conter V, Arico M, Valsecchi MG, et al. Extended intrathecal methotrexate may replace cranial irradiation for prevention of CNS relapse in children with intermediate-risk acute lymphoblastic leukemia treated with Berlin-Frankfurt-Münster-based intensive chemotherapy. J Clin Oncol 1995; 13: 2497–2502. Medline 10.1200/JCO.1995.13.10.2497 CASPubMedWeb of Science®Google Scholar 16 Steinherz PG, Gaynon P, Miller DR, et al. Improved disease-free survival of children with acute lymphoblastic leukemia at high risk for early relapse with the New York regimen-a new intensive therapy protocol: a report from the childrens cancer study group. J Clin Oncol 1986; 4: 744–752. CASPubMedWeb of Science®Google Scholar 17 Van Eys J, Berry D, Crist W, et al. A comparison of two regimens for high-risk acute lymphocytic leukemia in childhood: a Pediatric Oncology Group study. Cancer 1989; 63: 23–29. Medline 10.1002/1097-0142(19890101)63:1 3.0.CO;2-H CASPubMedWeb of Science®Google Scholar 18 Cherlow JM, Steinherz PG, Sather HN, et al. The role of radiation therapy in the treatment of acute lymphoblastic leukemia with lymphomatous presentation: a report from the children's cancer group. Int J Radiation Oncology Biol Phys 1993; 27: 1001–1009. Medline 10.1016/0360-3016(93)90516-X CASPubMedWeb of Science®Google Scholar 19 Gelber RD, Sallan ES, Cohen HJ, et al. Central nervous system treatment in childhood acute lymphoblastic leukemia: long-term follow up of patients diagnosed between 1973 and 1985. Cancer 1993; 72: 261–270. Medline 10.1002/1097-0142(19930701)72:1 3.0.CO;2-O CASPubMedWeb of Science®Google Scholar 20 Hiyoshi Y, Fujimoto T, Kuriya N, et al. Prognostic factors in children with acute lymphoblastic leukemia. II. Multivariate analysis. Jpn J Clin Oncol 1985; 15: 13–23. Medline CASPubMedWeb of Science®Google Scholar 21 Koizumi S, Fujimoto T. Improvement in treatment of childhood acute lymphoblastic leukemia: a 10-year study by the children's cancer and leukemia study group. Int J Hematol 1994; 59: 99–112. Medline CASPubMedWeb of Science®Google Scholar 22 Koizumi S, Fujimoto T, Oka T, et al. Overview of clinical studies of childhood acute lymphoblastic leukemia for more than ten years by the Japanese children's cancer and leukemia study group. Pediat Hematol Oncol 1997; 14: 17–28. Medline 10.3109/08880019709030881 CASWeb of Science®Google Scholar 23 Gelman R, Gelber R, Henderson C, et al. Improved methodology for analyzing local and distant recurrence. J Clin Oncol 1990; 8: 548–555. Medline 10.1200/JCO.1990.8.3.548 CASPubMedWeb of Science®Google Scholar 24 Kramar A, Arriagada R. Analyzing local and distant recurrence. J Clin Oncol 1990; 8: 2086–2087. Web of Science®Google Scholar 25 Arriagada R, Kramar A, Le Chevalier T, et al. Competing events determining relapse-free survival in limited small-cell lung carcinoma. J Clin Oncol 1992; 10: 447–451. Medline 10.1200/JCO.1992.10.3.447 PubMedWeb of Science®Google Scholar 26 Millot F, Rubie H, Mazingue F, et al. Cerebrospinal fluid drug levels of leukemic children receiving intravenous 5 g/m2 methotrexate. Leuk Lymphoma 1994; 12: 141–144. 10.3109/10428199409049660 Web of Science®Google Scholar Citing Literature Volume32, Issue4April 1999Pages 259-266 ReferencesRelatedInformation
Referência(s)