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Blood, 1 May 2008, Vol. 111, No. 9, pp. 4477-4489. Prepublished online as a Blood First Edition Paper on February 19, 2008; DOI 10.1182/blood-2007-09-112920. This Article Full Text Full Text (PDF) Supplemental Appendix and Tables All Versions of this Article: blood-2007-09-112920v1 111/9/4477    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Google Scholar Articles by Möricke, A. Articles by Schrappe, M. PubMed PubMed Citation Articles by Möricke, A. Articles by Schrappe, M. Related Collections Free Research Articles Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95 Anja Möricke1, Alfred Reiter2, Martin Zimmermann3, Helmut Gadner4, Martin Stanulla3, Michael Dördelmann5, Lutz Löning6, Rita Beier7, Wolf-Dieter Ludwig8, Richard Ratei8, Jochen Harbott2, Joachim Boos9, Georg Mann4, Felix Niggli10, Andreas Feldges11, Günter Henze12, Karl Welte3, Jörn-Dirk Beck13, Thomas Klingebiel14, Charlotte Niemeyer15, Felix Zintl16, Udo Bode17, Christian Urban18, Helmut Wehinger19, Dietrich Niethammer20, Hansjörg Riehm3, Martin Schrappe, for the German-Austrian-Swiss ALL-BFM Study Group1 1 Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; 2 Pediatric Hematology and Oncology, Justus-Liebig University, Gieβen, Germany; 3 Division of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany; 4 St Anna Kinderspital, Vienna, Austria; 5 Division of Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany; 6 Department of Pediatrics, Klinikum Oldenburg, Oldenburg, Germany; 7 Pediatric Hematology/Oncology, University Children's Hospital, Homburg/Saar, Germany; 8 Hematology/Oncology, Robert-Rössle-Klinik at the HELIOS Klinikum, Charité, Berlin, Germany; 9 Pediatric Hematology/Oncology, University Children's Hospital, Münster, Germany; 10 Department of Pediatric Oncology, University Children's Hospital, Zürich, Switzerland; 11 Pediatric Hematology/Oncology, Ostschweizer Kinderspital, St Gallen, Switzerland; 12 Pediatric Hematology and Oncology, Charité Medical Center, Humboldt University, Berlin, Germany; 13 Department of Pediatric Oncology, University Hospital, Erlangen, Germany; 14 Pediatric Hematology and Oncology, University Hospital, Frankfurt, Germany; 15 Division of Pediatric Hematology and Oncology, University of Freiburg, Freiburg, Germany; 16 Department of Pediatric Hematology and Oncology, University Hospital, Jena, Germany; 17 Division of Pediatric Hematology and Oncology, University Hospital, Bonn, Germany; 18 Division of Pediatric Hematology and Oncology, Medical University Graz, Graz, Austria; 19 Department of Pediatrics, Municipal Hospital, Kassel, Germany; and 20 Department of Pediatric Hematology and Oncology, University Hospital, Tübingen, Germany The trial ALL-BFM 95 for treatment of childhood acute lymphoblastic leukemia was designed to reduce acute and long-term toxicity in selected patient groups with favorable prognosis and to improve outcome in poor-risk groups by treatment intensification. These aims were pursued through a stratification strategy using white blood cell count, age, immunophenotype, treatment response, and unfavorable genetic aberrations providing an excellent discrimination of risk groups. Estimated 6-year event-free survival (6y-pEFS) for all 2169 patients was 79.6% (± 0.9%). The large standard-risk (SR) group (35% of patients) achieved an excellent 6y-EFS of 89.5% (± 1.1%) despite significant reduction of anthracyclines. In the medium-risk (MR) group (53% of patients), 6y-pEFS was 79.7% (± 1.2%); no improvement was accomplished by the randomized use of additional intermediate-dose cytarabine after consolidation. Omission of preventive cranial irradiation in non–T-ALL MR patients was possible without significant reduction of EFS, although the incidence of central nervous system relapses increased. In the high-risk (HR) group (12% of patients), intensification of consolidation/reinduction treatment led to considerable improvement over the previous ALL-BFM trials yielding a 6y-pEFS of 49.2% (± 3.2%). Compared without previous trial ALL-BFM 90, consistently favorable results in non-HR patients were achieved with significant treatment reduction in the majority of these patients. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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