Long-term outcome evaluation of medium/high risk acute lymphoblastic leukaemia children treated with or without cranial radiotherapy in the EORTC 58832 randomized study.

Autor: Piette C; Division of Haematology-Oncology, Department of Paediatrics, University Hospital Liège and University of Liège, Liège, Belgium., Suciu S; EORTC Headquarters, Brussels, Belgium., Bertrand Y; Department of Paediatric Onco-Haematology, Lyon University Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France., Uyttebroeck A; Department of Paediatric Haematology-Oncology, University Hospitals Leuven, Leuven, Belgium., Vandecruys E; Department of Paediatric Haematology-Oncology, Ghent University Hospital, Ghent, Belgium., Plat G; Department of Paediatric Onco-Haematology, Purpan University Hospital, Toulouse, France., Paillard C; Department of Haematology, Hautepierre University Hospital, Strasbourg, France., Pluchart C; Department of Paediatric Onco-Haematology, Reims University Hospital, Reims, France., Sirvent N; Department of Paediatric Onco-Haematology, Montpellier University Hospital, Montpellier, France., Maurus R; Department of Paediatric Onco-Haematology, Saint-Pierre Hospital, Brussel, Belgium., Poirée M; Department of Paediatric Onco-Haematology, Nice University Hospital, Nice, France., Simon P; Department of Paediatric Onco-Haematology, Besançon University Hospital, Besançon, France., Ferster A; Department of Paediatric Onco-Haematology, Hôpital Universitaire des Enfants Reine Fabiola (ULB), Brussels, Belgium., Hoyoux C; Division of Haematology-Oncology, Department of Paediatrics, University Hospital Liège and University of Liège, Liège, Belgium., Mazingue F; Department of Paediatric Haematology-Oncology, Lille University Hospital, Lille, France., Paulus R; CHR Verviers East Belgium, Verviers, Belgium., Freycon C; Department of Paediatric Onco-Haematology, Grenoble University Hospital, La Tronche, France., Thomas C; Department of Paediatric Onco-Haematology, Nantes University Hospital, Nantes, France., Philippet P; Department of Paediatric Onco-Haematology, CHC, Liège, Belgium., Gilotay C; EORTC Headquarters, Brussels, Belgium., van der Werff Ten Bosch J; Department of Paediatric Onco-Haematology, Universitair Ziekenhuis Brussel, Brussels, Belgium., Rohrlich PS; Department of Paediatric Onco-Haematology, Nice University Hospital, Nice, France., Benoit Y; Department of Paediatric Haematology-Oncology, Ghent University Hospital, Ghent, Belgium.
Jazyk: angličtina
Zdroj: British journal of haematology [Br J Haematol] 2020 Apr; Vol. 189 (2), pp. 351-362. Date of Electronic Publication: 2019 Dec 13.
DOI: 10.1111/bjh.16337
Abstrakt: We investigated the long-term outcome, the incidence of second neoplasms (SN) and the rate of late adverse effects (LAE) in children with central nervous system (CNS) negative medium/high-risk de novo acute lymphoblastic leukaemia (ALL), in first complete remission (CR1) at end of late intensification, randomized to receive no cranial radiotherapy (No CRT, n = 92) versus CRT (standard arm, n = 84) in the non-inferiority EORTC 58832 study (1983-1989). Median follow-up was 20 years (range 4-32 years). The 25-year disease-free survival rate (±SE) was 67·4 ± 4·9% without CRT and 70·2 ± 5·0% with CRT. The 25-year incidence of isolated (6·5 ± 2·6% vs. 4·8 ± 2·3%) and any CNS relapse {8·7 ± 2·9% vs. 11·9 ± 3·5%; hazard ratio (HR) 0·71 [95% confidence interval (CI) 0·28-1·79]; test of non-inferiority: P = 0·01} was not increased without CRT. The 25-year SN incidence in CR1 was 7·9 ± 4·6% vs. 11·0 ± 4·2%. The 25-year event-free and overall survival rates were quite similar in both arms [59·5 ± 6·3% vs. 60·5 ± 5·9%, HR 0·94 (95% CI 0·57-1·52), and 78·1 ± 4·3% vs. 78·5 ± 4·5%, HR 1·00 (95% CI 0·53-1·88)]. Omission of CRT was associated with dramatic decrease in CNS and endocrine LAE rates. In conclusion, our data suggest that, with proper systemic and intrathecal CNS prophylaxis, CRT could totally be omitted in CR1 without jeopardizing survival, while decreasing LAE in childhood ALL.
(© 2019 British Society for Haematology and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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