Augmented Berlin-Frankfurt-Munster therapy abrogates the adverse prognostic significance of slow early response to induction chemotherapy for children and adolescents with acute lymphoblastic leukemia and unfavorable presenting features: A report from the Children's Cancer Group

被引:99
作者
Nachman, J
Sather, HN
Gaynon, PS
Lukens, JN
Wolff, L
Trigg, ME
机构
[1] UNIV CHICAGO, CHICAGO, IL 60637 USA
[2] UNIV SO CALIF, SCH MED, LOS ANGELES, CA USA
[3] UNIV WISCONSIN, MED CTR, MADISON, WI 53706 USA
[4] VANDERBILT UNIV, NASHVILLE, TN USA
[5] OREGON HLTH SCI UNIV, PORTLAND, OR 97201 USA
[6] UNIV IOWA HOSP & CLIN, IOWA CITY, IA 52242 USA
关键词
D O I
10.1200/JCO.1997.15.6.2222
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Compared with previous Children's Cancer Group (CCG) acute lymphoblastic leukemia (ALL) trials, therapy based on the Berlin-Frankfurt-Munster (BFM) 76 trial has effected an improvement in event-free survival (EFS), In an attempt to improve EF5 further, CCG investigators formulated on augmented BFM (A-BFM) regimen that provides prolonged, intensified postinduction chemotherapy relative to the CCG-modified BFM regimen. Patients and Methods: We tested A-BFM in 101 patients with ALL and unfavorable presenting features that showed slow early response (SER) to induction therapy who attained remission on day 28, Their outcome was compared with that of 251 concurrent patients with unfavorable presenting features, a rapid early response to therapy (RER), and remission by day 28, treated with CCG-BFM with or without cranial radiation (CRT), Results: The 4-year EF5 Fate from the end of induction for SER patients treated with A-BFM was 70.8% +/- 4.6%, Seventeen patients remain in continuous remission beyond 5 years, Vincristine (VCR) neurotoxicity developed in 50% of patients, but was rarely debilitating, Allergies to Escherichia coli L-asparaginase (L-ASP) occurred in 35% of patients, Avascular necrosis of bone (AVN) developed in 9% of patients, in comparison, a concurrent RER group treated with standard BFM +/- CRT had a sf-year EF5 rate of 73.1% +/- 4.6%, Conclusion: The toxicity of A-BFM is significant, but acceptable, Compared with historical control SER patients treated with CCG-modified BFM, A-BFM therapy appears to produce a significant improvement in EFS, This is the first study to show that intensive chemotherapy, as given in the A-BFM regimen, can abrogate the adverse prognostic significance of SER. (C) 1997 by American Society of Clinical Oncology.
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页码:2222 / 2230
页数:9
相关论文
共 16 条
  • [1] PROLONGED 2ND REMISSIONS IN CHILDHOOD ACUTE LYMPHOCYTIC-LEUKEMIA - A REPORT FROM THE CHILDRENS-CANCER-STUDY-GROUP
    BAUM, E
    NACHMAN, J
    RAMSAY, N
    WEETMAN, B
    NEERHOUT, R
    LITTMAN, P
    GRIFFIN, T
    NORRIS, D
    SATHER, H
    [J]. MEDICAL AND PEDIATRIC ONCOLOGY, 1983, 11 (01): : 1 - 7
  • [2] PERSISTENCE OF CIRCULATING BLASTS AFTER 1 WEEK OF MULTIAGENT CHEMOTHERAPY CONFERS A POOR-PROGNOSIS IN CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA
    GAJJAR, A
    RIBEIRO, R
    HANCOCK, ML
    RIVERA, GK
    MAHMOUD, H
    SANDLUND, JT
    CRIST, WM
    PUI, CH
    [J]. BLOOD, 1995, 86 (04) : 1292 - 1295
  • [3] IMPROVED THERAPY FOR CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA AND UNFAVORABLE PRESENTING FEATURES - A FOLLOW-UP REPORT OF THE CHILDRENS CANCER GROUP-STUDY CCG-106
    GAYNON, PS
    STEINHERZ, PG
    BLEYER, WA
    ABLIN, AR
    ALBO, VC
    FINKLESTEIN, JZ
    GROSSMAN, NJ
    NOVAK, LJ
    PYESMANY, AF
    REAMAN, GH
    CHAPPELL, RJ
    SATHER, HN
    HAMMOND, GD
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 1993, 11 (11) : 2234 - 2242
  • [4] DAY-7 MARROW RESPONSE AND OUTCOME FOR CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA AND UNFAVORABLE PRESENTING FEATURES
    GAYNON, PS
    BLEYER, A
    STEINHERZ, PG
    FINKLESTEIN, JZ
    LITTMAN, P
    MILLER, DR
    REAMAN, G
    SATHER, H
    HAMMOND, GD
    [J]. MEDICAL AND PEDIATRIC ONCOLOGY, 1990, 18 (04): : 273 - 279
  • [5] NONPARAMETRIC-ESTIMATION FROM INCOMPLETE OBSERVATIONS
    KAPLAN, EL
    MEIER, P
    [J]. JOURNAL OF THE AMERICAN STATISTICAL ASSOCIATION, 1958, 53 (282) : 457 - 481
  • [6] KASPERS GJL, 1994, BLOOD, V84, pA516
  • [7] LAUER SJ, 1987, CANCER, V60, P2366, DOI 10.1002/1097-0142(19871115)60:10<2366::AID-CNCR2820601003>3.0.CO
  • [8] 2-U
  • [9] MANTEL NATHAN, 1966, CANCERCHEMOTHERAP REP, V50, P163
  • [10] DESIGN AND ANALYSIS OF RANDOMIZED CLINICAL-TRIALS REQUIRING PROLONGED OBSERVATION OF EACH PATIENT .2. ANALYSIS AND EXAMPLES
    PETO, R
    PIKE, MC
    ARMITAGE, P
    BRESLOW, NE
    COX, DR
    HOWARD, SV
    MANTEL, N
    MCPHERSON, K
    PETO, J
    SMITH, PG
    [J]. BRITISH JOURNAL OF CANCER, 1977, 35 (01) : 1 - 39