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Efficacy of high-dose methotrexate in childhood acute lymphocytic leukemia:
analysis by contemporary risk classifications
M Abromowitch, J Ochs, CH Pui, D Fairclough, SB Murphy and GK Rivera
Department of Hematology-Oncology, St. Jude Children's Research Hospital,
Memphis, TN 38101.
High-dose methotrexate (HDMTX) added to a basic regimen of chemotherapy
proved superior to cranial irradiation and sequentially administered drug
pairs (RTSC) in prolonging complete remissions in children with
"standard-risk" acute lymphocytic leukemia. To extend this result to more
contemporary risk groups, we reclassified the patients according to methods
of the Pediatric Oncology Group (POG), the Childrens Cancer Study Group
(CCG), the Rome workshop, and St Jude Total Therapy Study XI. By life table
analysis, 70% to 78% of patients with a favorable prognosis would remain in
continuous complete remission (CCR) at 4 years if treated with HDMTX.
Uniformly lower CCR rates could be expected with RTSC, especially in St
Jude better-risk patients. HDMTX also would show greater efficacy than RTSC
in the CCG average-risk and POG poor-risk groups, but the results appear
inferior to those being achieved with intensified regimens for high-risk
leukemia. Although both therapies would provide adequate CNS prophylaxis in
favorable-risk groups, RTSC would offer greater protection in patients
classified as being in a worse-risk group by St Jude criteria. We conclude
that HDMTX- based therapy, as described in this report, would be most
effective in patients with a presenting leukocyte count of less than 25 x
10(9)/L, of the white race, aged 2 to 10 years, and having leukemic cell
hyperdiploidy without translocations.
Volume 71,
Issue 4,
pp. 866-869,
04/01/1988
Copyright © 1988 by The American Society of Hematology
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