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Effectiveness of intensified rotational combination chemotherapy for late
hematologic relapse of childhood acute lymphoblastic leukemia
GK Rivera, MM Hudson, Q Liu, E Benaim, RC Ribeiro, WM Crist and CH Pui
Department of Hematology-Oncology, St Jude Children's Research Hospital,
Memphis, TN 38105, USA.
Relapsed acute lymphoblastic leukemia (ALL) usually carries a dire
prognosis. We evaluated the effectiveness and long-term complications of
intensive rotational combination chemotherapy for late hematologic relapse
(median, 16 months after elective cessation of therapy) among 34 children
and young adults (ages 4 to 23 years). Concurrent central nervous system
(CNS) relapse was present in 3 cases and testicular relapse in 4. Secondary
therapy comprised an intensive five-drug reinduction (6 weeks) followed by
continuation treatment with four drug pairs, rotated weekly in 4-week
cycles over 120 weeks. Intrathecal chemotherapy (methotrexate,
hydrocortisone, cytarabine) was given three times during reinduction and
every 8 weeks during continuation. Treatment was electively discontinued at
week 120 in the absence of detectable disease. Thirty-three patients (97%)
attained a second complete remission. At a median follow-up of 9.3 years
(range, 4.5 to 11.4), estimates of 5-year second event-free and overall
survival (+/- SE) are 65% +/- 8% and 79% +/- 7%, respectively. Eleven
patients had a second relapse (9 marrow, 2 testicular) and one developed
secondary myeloid leukemia. There have been no CNS relapses or deaths in
remission. Treatment was well-tolerated and was given largely on an
outpatient basis. Late effects are primarily endocrinologic; one child had
a second malignant solid tumor (presumed related to initial radiation
therapy) that was treated successfully. Intensive treatment with
alternating non-cross-resistant drug pairs for late hematologic relapses of
ALL is effective and well-tolerated, and produces results similar to those
achieved in patients with newly diagnosed ALL. Event- free survival
compares favorably with reports of other relapse regimens, including those
incorporating bone marrow transplantation.
Volume 88,
Issue 3,
pp. 831-837,
08/01/1996
Copyright © 1996 by The American Society of Hematology
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