|
|
Blood, 15 August 2006, Vol. 108, No. 4, pp. 1165-1173.
Prepublished online as a Blood First Edition Paper on April 11, 2006; DOI 10.1182/blood-2005-12-011809.
 Previous Article | Next Article 
Submitted December 6, 2005
Accepted March 24, 2006
Intrathecal triple therapy decreases central nervous
system relapse but fails to improve event-free survival
when compared to intrathecal methotrexate: results of
the Children's Cancer Group (CCG) 1952 study for
standard-risk acute lymphoblastic leukemia. A report
from the Children's Oncology Group
Yousif Matloub*, Susan Lindemulder, Paul S. Gaynon, Harland Sather, Mei La, Emmett Broxson, Rochelle Yanofsky, Raymond Hutchinson, Nyla A. Heerema, James Nachman, Marilyn Blake, Linda M. Wells, April D. Sorrell, Margaret Masterson, John F. Kelleher, and Linda C. Stork
University of Wisconsin Children's Hospital, Madison
The Children's Hospital - Denver
Children's Hospital Los Angeles
Children's Oncology Group
Children's Medical Center Dayton
CancerCare Manitoba
C.S. Mott Children's Hospital
Columbus Children's Hospital
University of Chicago Medical Center
South Carolina Cancer Center
University of Medicine and Dentistry of New Jersey
Sacred Heart Hospital
Oregon Health & Science University
* Corresponding author; email: yhmatloub{at}wisc.edu.
The CCG-1952 clinical trial for children with standard
risk acute lymphoblastic leukemia (SR-ALL) compared
intrathecal (IT) methotrexate (MTX) with IT triples
(ITT) [MTX, cytarabine, and hydrocortisone sodium
succinate (HSS)] as pre-symptomatic central nervous
system (CNS) treatment. Following remission induction,
1018 patients were randomized to receive IT MTX and 1009
ITT. Multivariate analysis identified male gender,
hepatomegaly, CNS-2 status, and age < 2 or > 6 years as
significant predictors of isolated CNS (iCNS) relapse.
The 6-year cumulative incidence estimates of iCNS
relapse are 3.4 ± 1.0% for ITT and 5.9 ±
1.2% for IT MTX, p = 0.004. Significantly more relapses
occurred in bone marrow and testicles with ITT than IT
MTX, particularly among patients with T-cell phenotype
or day 14 marrow (BM) aspirate containing 5-25% blasts.
Thus, the estimated 6-year event free survival (EFS)
with ITT or IT MTX are equivalent at 80.7 ± 1.9%
and 82.5 ± 1.8%, respectively, p = 0.3. Because
the salvage rate after BM relapse is inferior to that
after CNS relapse, the 6-year overall survival (OS) for
ITT is 90.3 ± 1.5% vs 94.4 ± 1.1% for IT
MTX, p = 0.01. It appears that ITT improves pre-
symptomatic CNS treatment, but does not improve overall
outcome.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
C.-H. Pui, D. Campana, D. Pei, W. P. Bowman, J. T. Sandlund, S. C. Kaste, R. C. Ribeiro, J. E. Rubnitz, S. C. Raimondi, M. Onciu, et al.
Treating Childhood Acute Lymphoblastic Leukemia without Cranial Irradiation
N. Engl. J. Med.,
June 25, 2009;
360(26):
2730 - 2741.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. L. Seibel
Treatment of Acute Lymphoblastic Leukemia in Children and Adolescents: Peaks and Pitfalls
Hematology,
January 1, 2008;
2008(1):
374 - 380.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Malempati, P. S. Gaynon, H. Sather, M. K. La, and L. C. Stork
Outcome After Relapse Among Children With Standard-Risk Acute Lymphoblastic Leukemia: Children's Oncology Group Study CCG-1952
J. Clin. Oncol.,
December 20, 2007;
25(36):
5800 - 5807.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-H. Pui
Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment
Hematology,
January 1, 2006;
2006(1):
142 - 146.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
