Childhood T-cell acute lymphoblastic leukemia: The Dana-Farber Cancer Institute acute lymphoblastic leukemia consortium experience

被引:236
作者
Goldberg, JM
Silverman, LB
Levy, DE
Dalton, VK
Gelber, RD
Lehmann, L
Cohen, HJ
Sallan, SE
Asselin, BL
机构
[1] Dana Farber Canc Inst, Dept Pediat Oncol, Boston, MA 02115 USA
[2] Dana Farber Canc Inst, Dept Biostat Sci, Boston, MA 02115 USA
[3] Childrens Hosp, Div Hematol Oncol, Boston, MA 02115 USA
[4] Harvard Univ, Sch Med, Dept Pediat, Boston, MA 02115 USA
[5] Stanford Univ, Sch Med, Dept Pediat, Stanford, CA 94305 USA
[6] Univ Rochester, Med Ctr, Dept Pediat, Div Hematol Oncol, Rochester, NY 14627 USA
关键词
D O I
10.1200/JCO.2003.10.116
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: T-cell acute lymphoblastic leukemia (T-ALL) accounts for 10% to 15% of newly diagnosed cases of childhood acute lymphoblastic leukemia (ALL). Historically, T-ALL patients have had a worse prognosis than other ALL patients. Patients and Methods: We reviewed the outcomes of 125 patients with T-ALL treated on Dana-Farber Cancer Institute (DFCI) ALL Consortium trials between 1981 and 1995. Therapy included four- or five-agent remission induction; consolidation therapy with doxorubicin, vincristine, corticosteroid, mercaptopurine, and weekly high-dose asparaginase; and cranial radiation. T-ALL patients were treated the same as high-risk B-progenitor ALL patients. Fifteen patients with T-cell lymphoblastic lymphoma were also treated with the same high-risk regimen between 1981 and 2000. Results: The 5-year event-free survival (EFS) rate for T-ALL patients was 75% +/- 4%. Fourteen of 15 patients with T-cell lymphoblastic lymphoma were long-term survivors. There was no significant difference in EFS comparing patients with T-ALL and B-progenitor ALL (P = .56), although T-ALL patients had significantly higher rates of induction failure (P < .0001), and central nervous system (CNS) relapse (P = .02). The median time to relapse in T-ALL patients was 1.2 years versus 2.5 years in B-progenitor ALL patients (P = .001). There were no pretreatment characteristics associated with worse prognosis in patients with T-ALL. Conclusion: T-ALL patients fared as well as B-progenitor patients on DFCI ALL Consortium protocols. Patients with T-ALL remain at increased risk for induction failure, early relapse, and isolated CNS relapse. Future studies should focus on the identification of and treatment for T-ALL patients at high risk for treatment failure. (C) 2003 by American Society of Clinical Oncology.
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收藏
页码:3616 / 3622
页数:7
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