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Blood, 1 March 2008, Vol. 111, No. 5, pp. 2548-2555. Prepublished online as a Blood First Edition Paper on November 26, 2007; DOI 10.1182/blood-2007-02-070342. This Article Full Text (PDF) Supplemental Appendix Erratum (v111,p5262) All Versions of this Article: blood-2007-02-070342v1 111/5/2548    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Seibel, N. L Articles by Gaynon, P. S Search for Related Content PubMed PubMed Citation Articles by Seibel, N. L Articles by Gaynon, P. S Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted February 15, 2007 Accepted October 28, 2007 Early post-induction intensification therapy improves survival for children and adolescents with high-risk acute lymphoblastic leukemia: a report from the Children's Oncology Group Nita L Seibel*, Peter G Steinherz, Harland N Sather, James B Nachman, Cynthia DeLaat, Lawrence J Ettinger, David R. Freyer, Leonard A. Mattano Jr, Caroline A Hastings, Charles M. Rubin, Kathy Bertolone, Janet L Franklin, Nyla A. Heerema, Torrey L. Mitchell, Allan F. Pyesmany, Mei K. La, Cheryl Edens, and Paul S Gaynon Hematology/Oncology, Childrens National Medical Center & George Washington University School of Medicine & Public Health, Washington, D.C. Memorial Sloan Kettering Cancer Center, New York, NY Group Operations Center, Children's Oncology Group, Arcadia, CA University of Chicago Comer Children's Hospital, Chicago, IL Cincinnati Childrens Hospital Medical Center, Cincinnati, OH St. Peter's University Hospital, New Brunswick, NJ DeVos Children's Hospital, Grand Rapids, MI Kalamazoo Center for Medical Studies, Kalamazoo, MI Children's Hospital and Research Center Oakland, Oakland, CA Kosair Childrens Hospital, Louisville, KY Childrens Hospital of Los Angeles, Los Angeles, CA Ohio State University College of Medicine, Columbus, OH Raymond Blank Children's Hospital, Des Moines, IA IWK Health Center, Halifax, Nova Scotia, Canada Department of Hematology/Oncology, Vanderbilt University, Nashville, TN * Corresponding author; email: nseibel{at}cnmc.org. Longer and more intensive post induction intensification (PII) improved the outcome of children and adolescents with "higher risk" acute lymphoblastic leukemia (ALL) and a slow marrow response to induction therapy. In the Children's Cancer Group study (CCG-1961), we tested longer versus more intensive PII, employing a 2 X 2 factorial design for children with higher risk ALL and a rapid marrow response to induction therapy. Between November, 1996 and May, 2002, 2078 children and adolescents with newly diagnosed ALL (1 to 9 years old with white blood count (WBC) of 50,000/mm3 or 10 years of age with any WBC) were enrolled. After induction, 1299 patients with marrow blasts 25% on day 7 of induction [rapid early responders (RER)] were randomized to standard or longer duration (n= 651 + 648) and standard or increased intensity (n=649 + 650) PII. Stronger intensity PII improved EFS (81% vs 72%, p<0.001) and S (89% vs 83%, p=0.003) at 5 years. Differences were most apparent after two years from diagnosis. Longer duration PII provided no benefit. Stronger intensity but not prolonged duration PII improved outcome for patients with higher risk ALL. This study is registered at http://clinicaltrials.gov as NCT00002812. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: J. B. Nachman, M. K. La, S. P. Hunger, N. A. Heerema, P. S. Gaynon, C. Hastings, L. A. Mattano Jr, H. Sather, M. Devidas, D. R. Freyer, et al. Young Adults With Acute Lymphoblastic Leukemia Have an Excellent Outcome With Chemotherapy Alone and Benefit From Intensive Postinduction Treatment: A Report From the Children's Oncology Group J. Clin. Oncol., November 1, 2009; 27(31): 5189 - 5194. [Abstract] [Full Text] [PDF] C.-H. Pui Toward a Total Cure for Acute Lymphoblastic Leukemia J. Clin. Oncol., November 1, 2009; 27(31): 5121 - 5123. [Full Text] [PDF] E. L. Korn, B. Freidlin, and M. Mooney Stopping or Reporting Early for Positive Results in Randomized Clinical Trials: The National Cancer Institute Cooperative Group Experience From 1990 to 2005 J. Clin. Oncol., April 1, 2009; 27(10): 1712 - 1721. [Abstract] [Full Text] [PDF] D. R. Freyer, N. L. Seibel, M. K La, M. Devidas, W. L. Carroll, S. P. Hunger, and P. S. Gaynon Survival after Relapse in Higher Risk Acute Lymphoblastic Leukemia (ALL) in Children and Adolescents Is Independent of Prior Treatment Intensity: A Report from the Children's Oncology Group (COG). Blood (ASH Annual Meeting Abstracts), November 16, 2008; 112(11): 917 - 917. [Abstract] D. Bhojwani, H. Kang, R. X. Menezes, W. Yang, H. Sather, N. P. Moskowitz, D.-J. Min, J. W. Potter, R. Harvey, S. P. Hunger, et al. Gene Expression Signatures Predictive of Early Response and Outcome in High-Risk Childhood Acute Lymphoblastic Leukemia: A Children's Oncology Group Study J. Clin. Oncol., September 20, 2008; 26(27): 4376 - 4384. [Abstract] [Full Text] [PDF] D. Pulte, A. Gondos, and H. Brenner Trends in 5- and 10-year Survival After Diagnosis with Childhood Hematologic Malignancies in the United States, 1990-2004 J Natl Cancer Inst, September 17, 2008; 100(18): 1301 - 1309. [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]

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