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Early Intensification of Intrathecal Chemotherapy Virtually
Eliminates Central Nervous System Relapse in Children With Acute
Lymphoblastic Leukemia
Ching-Hon Pui,
Hazem H. Mahmoud,
Gaston K. Rivera,
Michael L. Hancock,
John T. Sandlund,
Frederick G. Behm,
David R. Head,
Mary V. Relling,
Raul C. Ribeiro,
Jeffrey E. Rubnitz,
Larry E. Kun, and
William
E. Evans
From the Departments of Hematology-Oncology, Pathology and Laboratory
Medicine, Pharmaceutical Sciences, Biostatistics and Radiation
Oncology, St Jude Children's Research Hospital, and Department of
Pediatrics, Pharmacy and Radiation Oncology, University of Tennessee,
College of Medicine, Memphis, TN.
Central nervous system (CNS) relapse has been an obstacle to
uniformly successful treatment of childhood acute lymphoblastic leukemia (ALL) for many years. We therefore intensified intrathecal chemotherapy (simultaneously administered methotrexate, hydrocortisone, and cytarabine) for 165 consecutive children with newly diagnosed ALL
enrolled in Total Therapy Study XIIIA from December 1991 to August
1994. The 64 patients (39%) who had 1 or more blast cells in
cytocentrifuged preparations of cerebrospinal fluid at diagnosis, with
or without associated higher-risk features, received additional doses
of intrathecal chemotherapy during remission induction and the first
year of continuation treatment. Patients with higher-risk leukemia,
regardless of cerebrospinal fluid findings, also received additional
doses of intrathecal chemotherapy during the first year of continuation
treatment. Cranial irradiation was reserved for patients with
higher-risk leukemia (22% of the total). The 5-year cumulative risk of
an isolated CNS relapse among all 165 patients was 1.2% (95%
confidence interval, 0% to 2.9%), whereas that of any CNS relapse was
3.2% (0.4% to 6.0%). The probability of surviving for 5 years
without an adverse event of any type was 80.2% ± 9.2% (SE). Our
results suggest that early intensification of intrathecal chemotherapy
will reduce the risk of CNS relapse to a very low level in children
with ALL, securing a higher event-free survival rate overall.
Blood, Vol. 92 No. 2 (July 15), 1998:
pp. 411-415
© 1998 by the American Society of Hematology.
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|
|
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|
|
|
|
|
|
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June 15, 2006;
107(12):
4961 - 4967.
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[Full Text]
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|
|
|
|
|
|
|
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January 15, 2006;
107(2):
769 - 776.
[Abstract]
[Full Text]
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|
|
|
|
|
|
|
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December 20, 2005;
102(51):
18556 - 18561.
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|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
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June 17, 2002;
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|
|
|
|
|
|
|
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February 1, 2002;
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[Full Text]
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|
|
|
|
|
|
|
A. Lister, L. E. Abrey, and J. T. Sandlund
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January 1, 2002;
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|
|
|
|
|
|
|
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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19(13):
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[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Strauss, J. T. Su, V. M. K. Dalton, R. D. Gelber, S. E. Sallan, and L. B. Silverman
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J. Clin. Oncol.,
June 15, 2001;
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[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. B. Silverman, R. D. Gelber, V. K. Dalton, B. L. Asselin, R. D. Barr, L. A. Clavell, C. A. Hurwitz, A. Moghrabi, Y. Samson, M. A. Schorin, et al.
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March 1, 2001;
97(5):
1211 - 1218.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. L. Greenberg, V. Gordeuk, S. Issaragrisil, N. Siritanaratkul, S. Fucharoen, and R. C. Ribeiro
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January 1, 2001;
2001(1):
479 - 498.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Gajjar, P. L. Harrison, J. T. Sandlund, G. K. Rivera, R. C. Ribeiro, J. E. Rubnitz, B. Razzouk, M. V. Relling, W. E. Evans, J. M. Boyett, et al.
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Blood,
November 15, 2000;
96(10):
3381 - 3384.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Coustan-Smith, J. Sancho, M. L. Hancock, J. M. Boyett, F. G. Behm, S. C. Raimondi, J. T. Sandlund, G. K. Rivera, J. E. Rubnitz, R. C. Ribeiro, et al.
Clinical importance of minimal residual disease in childhood acute lymphoblastic leukemia
Blood,
October 15, 2000;
96(8):
2691 - 2696.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. A. Heerema, H. N. Sather, M. G. Sensel, T. Zhang, R. J. Hutchinson, J. B. Nachman, B. J. Lange, P. G. Steinherz, B. C. Bostrom, G. H. Reaman, et al.
Prognostic Impact of Trisomies of Chromosomes 10, 17, and 5 Among Children With Acute Lymphoblastic Leukemia and High Hyperdiploidy (> 50 Chromosomes)
J. Clin. Oncol.,
May 9, 2000;
18(9):
1876 - 1887.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. H. Mahoney Jr, J. J. Shuster, R. Nitschke, S. Lauer, C. P. Steuber, and B. Camitta
Intensification With Intermediate-Dose Intravenous Methotrexate Is Effective Therapy for Children With Lower-Risk B-Precursor Acute Lymphoblastic Leukemia: A Pediatric Oncology Group Study
J. Clin. Oncol.,
March 13, 2000;
18(6):
1285 - 1294.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. M. Kantarjian, S. O’Brien, T. L. Smith, J. Cortes, F. J. Giles, M. Beran, S. Pierce, Y. Huh, M. Andreeff, C. Koller, et al.
Results of Treatment With Hyper-CVAD, a Dose-Intensive Regimen, in Adult Acute Lymphocytic Leukemia
J. Clin. Oncol.,
February 1, 2000;
18(3):
547 - 547.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-H. Pui, J. M. Boyett, M. V. Relling, P. L. Harrison, G. K. Rivera, F. G. Behm, J. T. Sandlund, R. C. Ribeiro, J. E. Rubnitz, A. Gajjar, et al.
Sex Differences in Prognosis for Children With Acute Lymphoblastic Leukemia
J. Clin. Oncol.,
March 1, 1999;
17(3):
818 - 818.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-H. Pui and W. E. Evans
Acute Lymphoblastic Leukemia
N. Engl. J. Med.,
August 27, 1998;
339(9):
605 - 615.
[Full Text]
[PDF]
|
|
|
| |
