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Blood, 1 May 2008, Vol. 111, No. 9, pp. 4477-4489. Prepublished online as a Blood First Edition Paper on February 19, 2008; DOI 10.1182/blood-2007-09-112920. This Article Full Text (PDF) Supplemental Appendix and Tables All Versions of this Article: blood-2007-09-112920v1 111/9/4477    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 CrossRef Citing Articles via Google Scholar Google Scholar Articles by Moricke, A. Articles by Schrappe, M. Search for Related Content PubMed PubMed Citation Articles by Moricke, A. Articles by Schrappe, M. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted September 26, 2007 Accepted February 1, 2008 Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95 Anja Moricke, Alfred Reiter, Martin Zimmermann, Helmut Gadner, Martin Stanulla, Michael Dordelmann, Lutz Loning, Rita Beier, Wolf-Dieter Ludwig, Richard Ratei, Jochen Harbott, Joachim Boos, Georg Mann, Felix Niggli, Andreas Feldges, Gunter Henze, Karl Welte, Jorn-Dirk Beck, Thomas Klingebiel, Charlotte Niemeyer, Felix Zintl, Udo Bode, Christian Urban, Helmut Wehinger, Dietrich Niethammer, Hansjorg Riehm, and Martin Schrappe* Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany Pediatric Hematology and Oncology, Justus-Liebig University, Gießen, Germany Division of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany Department of Hematology and Oncology, St. Anna Kinderspital, Vienna, Austria Division of Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany Department of Pediatrics, Klinikum Oldenburg gGmbH, Oldenburg, Germany Pediatric Hematology/Oncology, University Children's Hospital, Homburg/Saar, Germany Hematology/Oncology, Robert-Rossle-Klinik at the HELIOS Klinikum, Charite, Berlin, Germany Pediatric Hematology/Oncology, University Children's Hospital, Munster, Germany Department of Pediatric Oncology, University Children's Hospital, Zurich, Switzerland Pediatric Hematology/Oncology, Ostschweizer Kinderspital, St. Gallen, Switzerland Pediatric Hematology and Oncology, Charite Medical Center, Humboldt University, Berlin, Germany Department of Pediatric Oncology, University Hospital, Erlangen, Germany Pediatric Hematology and Oncology, University Hospital, Frankfurt, Germany Division of Pediatric Hematology and Oncology, University of Freiburg, Freiburg, Germany Department of Pediatric Hematology and Oncology, University Hospital, Jena, Germany Division of Pediatric Hematology and Oncology, University Hospital, Bonn, Germany Division of Pediatric Hematology and Oncology, Medical University Graz, Graz, Austria Department of Pediatrics, Municipal Hospital, Kassel, Germany Department of Pediatric Hematology and Oncology, University Hospital, Tubingen, Germany * Corresponding author; email: m.schrappe{at}pediatrics.uni-kiel.de. The trial ALL-BFM 95 for treatment of childhood acute lymphoblastic leukemia was designed to reduce acute and long-term toxicity in selected patient groups with favorable prognosis and to improve outcome in poor-risk groups by treatment intensification. The basis for these aims was set by a stratification strategy using white blood cell count, age, immunophenotype, treatment response and unfavorable genetic aberrations providing an excellent discrimination of distinct risk groups. Estimated 6-year event-free survival (6y-pEFS) for all 2169 patients was 79.6±0.9%. The large standard-risk (SR) group (35% of patients) achieved excellent 6y-EFS of 89.5±1.1% despite significant reduction of the daunorubicin dose. In the medium-risk (MR) group (53% of patients), 6y-pEFS was 79.7±1.2%; no improvement was accomplished by the randomized use of additional intermediate-dose cytarabine after consolidation. Omission of preventive cranial irradiation in Non-T-ALL MR patients was possible without significant reduction of EFS though the incidence of CNS relapses increased. In the small high-risk (HR) group (12% of patients), intensification of consolidation/reinduction treatment led to considerable improvement over the previous ALL-BFM trials yielding a 6y-pEFS of 49.2±3.2%. Compared with the previous trial ALL-BFM 90, consistently favorable results in non-HR patients were achieved with significant treatment reduction in the majority of these patients. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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