| Autor: |
Schrappe, Martin, Reiter, Alfred, Ludwig, Wolf-Dieter, Harbott, Jochen, Zimmermann, Martin, Hiddemann, Wolfgang, Niemeyer, Charlotte, Henze, Gu¨nter, Feldges, Andreas, Zintl, Felix, Kornhuber, Bernhard, Ritter, Jo¨rg, Welte, Karl, Gadner, Helmut, Riehm, Hansjo¨rg |
| Zdroj: |
Blood; June 2000, Vol. 95 Issue: 11 p3310-3322, 13p |
| Abstrakt: |
Trial ALL-BFM 90 was designed to improve outcome in patients with childhood acute lymphoblastic leukemia (ALL) by using a reduced treatment regimen. Patients were stratified into a standard-risk group (SRG), a medium-risk group (MRG), both defined by adequate early treatment response; and a high-risk group (HRG), defined by inadequate response to the cytoreductive prednisone prephase, induction failure, or Philadelphia-chromosome–positive ALL. Four treatment modifications were evaluated: dose intensification in induction by a more rapid drug sequence; administration of l-asparaginase during consolidation therapy in the MRG (randomized); enforced consolidation by rotational elements in the HRG; and reduction in the dose of anthracyclines and use of only 12-Gy preventive cranial radiotherapy in the MRG and HRG, with the aim of avoiding toxicity. Among all 2178 patients (=?18 years of age), the 6-year event-free survival (EFS) rate (±?SE) was 78%?±?1%, with a median observation time of 4.8 years. EFS was 85%?±?2% in the SRG (n?=?636) and 82%?±?1% in the MRG (n?=?1299). l-asparaginase did not improve outcome in the MRG: the event-free interval was 83%?±?2% withl-asparaginase (n?=?528) and 81%?±?2% without it (n?=?557). Because there were more systemic relapses in the HRG (n?=?243), EFS was 34%?±?3%, an outcome inferior to that in the HRG in a previous trial, ALL-BFM 86, in which EFS was 47%?±?5% (P?=?.04). The rates of isolated central nervous system relapse in the MRG and HRG were 0.8% and 1.6%, respectively; thus, the 12-Gy preventive cranial radiotherapy regimen apparently provided sufficient central nervous system prophylaxis. The overall improvement over the results in ALL-BFM 86 (6-year EFS, 72%; P?=?.001) was based on fewer recurrences among patients in the MRG with B-cell-precursor ALL, indicating an advantage of more condensed induction therapy. In multivariate analysis, inadequate in vivo response emerged as the strongest adverse prognostic variable. |
| Databáze: |
Supplemental Index |
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