Reduced-dose intensity therapy for pediatric lymphoblastic leukemia: long-term results of the Recife RELLA05 pilot study.

Autor:	Pedrosa F; Department of Pediatric Oncology, Real Hospital Português, Recife, Brazil., Coustan-Smith E; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Zhou Y; Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN., Cheng C; Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN., Pedrosa A; Department of Pediatric Oncology, Real Hospital Português, Recife, Brazil., Lins MM; Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil; and., Pedrosa M; Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil; and., Lucena-Silva N; Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil; and., Ramos AML; Department of Pediatric Oncology, Real Hospital Português, Recife, Brazil., Vinhas E; Department of Pediatric Oncology, Real Hospital Português, Recife, Brazil., Rivera GK; Department of Global Pediatric Medicine., Campana D; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Ribeiro RC; Department of Global Pediatric Medicine.; Department of Oncology, and.; Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN.
Jazyk:	angličtina
Zdroj:	Blood [Blood] 2020 Apr 23; Vol. 135 (17), pp. 1458-1466.
DOI:	10.1182/blood.2019004215
Abstrakt:	Treatment-related mortality is common among children with acute lymphoblastic leukemia (ALL) treated in poor-resource settings. We applied a simplified flow cytometric assay to identify patients with precursor B-cell ALL (B-ALL) at very low risk (VLR) of relapse and treated them with a reduced-intensity treatment plan (RELLA05). VLR criteria include favorable presenting features (age ≥ 1 and < 10 years), white blood cell count of <50 ×109/L, lack of extramedullary leukemia, and minimal residual disease level of <0.01% on remission induction day 19. Except for 2 doses of daunorubicin, treatment of patients with VLR B-ALL consisted of a combination of agents with relatively low myelotoxicity profiles, including corticosteroids, vincristine, L-asparaginase, methotrexate, and 6-mercaptopurine. Cyclophosphamide, systemic cytarabine, and central nervous system radiotherapy were not used. Of 454 patients with ALL treated at the Instituto de Medicina Integral Professor Fernando Figueira in Recife, Brazil, between December 2005 and June 2015, 101 were classified as having VLR B-ALL. There were no cases of death resulting from toxicity or treatment abandonment during remission induction. At a median follow-up of 6.6 years, there were 8 major adverse events: 6 relapses, 1 treatment-related death (from septicemia) during remission, and 1 secondary myeloid leukemia. The estimated 5-year event-free and overall survival rates were 92.0% ± 3.9% and 96.0% ± 2.8%, respectively. The 5-year cumulative risk of relapse was 4.24% ± 2.0%. The treatment was well tolerated. Episodes of neutropenia were of short duration. Patients with B-ALL selected by a combination of presenting features and degree of early response can be successfully treated with a mildly myelosuppressive chemotherapy regimen. (© 2020 by The American Society of Hematology.)
Databáze:	MEDLINE
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