|
|
 Previous Article | Table of Contents | Next Article 
Importance of effective central nervous system therapy in isolated bone
marrow relapse of childhood acute lymphoblastic leukemia. BFM (Berlin-
Frankfurt-Munster) Relapse Study Group
C Buhrer, R Hartmann, R Fengler, S Schober, I Arlt, M Loewke and G Henze
Children's Hospital, Rudolf Virchow Medical Center, Berlin Free University,
Germany.
Presymptomatic central nervous system (CNS) treatment in children with a
late isolated first bone marrow (BM) relapse of acute lymphoblastic
leukemia (ALL) was based on intermediate-dose systemic and intrathecal (IT)
methotrexate (MTX) in the multicenter trial, ALL-REZ BFM 85. Because this
was associated with an excess of overt second CNS relapses, cranial
radiotherapy (cRT) plus prolonged triple IT therapy with MTX, cytarabine,
and prednisone was instituted during the course of the subsequent trial,
ALL-REZ BFM 87. Results of children with or without cRT, but otherwise
identical chemotherapy, are presented here. Between April 1985 and March
1990, 93 children with their first late isolated BM relapse of ALL were
entered on protocols ALL-REZ BFM 85M and ALL-REZ BFM 87. An intensive
6-month phase of multiagent chemotherapy that included 8 courses of
systemic MTX (1 g/m2) plus IT MTX was followed by 2 years of conventional
maintenance therapy with daily 6-thioguanine and biweekly MTX. Children
with bone marrow transplantation excluded, 73 were in complete remission at
the end of intensive polychemotherapy, 40 of whom received fractionated cRT
plus triple IT therapy during the following 6 months; 11 did not receive
cRT but prolonged triple IT; 22 received neither cRT nor prolonged triple
IT. Except for a higher percentage of children who had received cRT in
front-line protocols (29 of 33 v 20 of 40), the patient groups without or
with salvage cRT were comparable. Of 33 children without salvage cRT, 26
relapsed, compared with 21 of 40 who had received cRT (P < .05). The
difference was solely attributable to second relapses with CNS involvement
(10 of 33 v 1 of 40; P < .01). Estimated 6-year event- free survival
rates were .18 for children without cRT and .46 for children with cRT (P
< .01). In patients without cRT, no impact of prolonged IT therapy could
be shown. The data suggest that second CNS prophylaxis with cRT and
prolonged triple IT therapy in children with late isolated BM relapse of
ALL is effective in preventing CNS relapses, in reducing the overall
relapse rate, and in increasing the overall survival rate.
Volume 83,
Issue 12,
pp. 3468-3472,
06/15/1994
Copyright © 1994 by The American Society of Hematology
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
A. von Stackelberg, R. Hartmann, C. Buhrer, R. Fengler, G. Janka-Schaub, A. Reiter, G. Mann, K. Schmiegelow, R. Ratei, T. Klingebiel, et al.
High-dose compared with intermediate-dose methotrexate in children with a first relapse of acute lymphoblastic leukemia
Blood,
March 1, 2008;
111(5):
2573 - 2580.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Shalapour, A. Zelmer, M. Pfau, E. Moderegger, C. Costa-Blechschmidt, F. K.H. van Landeghem, T. Taube, I. Fichtner, C. Buhrer, G. Henze, et al.
The Thalidomide Analogue, CC-4047, Induces Apoptosis Signaling and Growth Arrest in Childhood Acute Lymphoblastic Leukemia Cells In vitro and In vivo.
Clin. Cancer Res.,
September 15, 2006;
12(18):
5526 - 5532.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Burkhardt, W. Woessmann, M. Zimmermann, U. Kontny, J. Vormoor, W. Doerffel, G. Mann, G. Henze, F. Niggli, W.-D. Ludwig, et al.
Impact of Cranial Radiotherapy on Central Nervous System Prophylaxis in Children and Adolescents With Central Nervous System-Negative Stage III or IV Lymphoblastic Lymphoma
J. Clin. Oncol.,
January 20, 2006;
24(3):
491 - 499.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. G. Einsiedel, A. von Stackelberg, R. Hartmann, R. Fengler, M. Schrappe, G. Janka-Schaub, G. Mann, K. Hahlen, U. Gobel, T. Klingebiel, et al.
Long-Term Outcome in Children With Relapsed ALL by Risk-Stratified Salvage Therapy: Results of Trial Acute Lymphoblastic Leukemia-Relapse Study of the Berlin-Frankfurt-Munster Group 87
J. Clin. Oncol.,
November 1, 2005;
23(31):
7942 - 7950.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Felix, B. J. Lange, and J. M. Chessells
Pediatric Acute Lymphoblastic Leukemia: Challenges and Controversies in 2000
Hematology,
January 1, 2000;
2000(1):
285 - 302.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
