Improved therapy for children with acute lymphoblastic leukemia and unfavorable presenting features: a follow-up report of the Childrens Cancer Group Study CCG-106
| Autor: | Neil J. Grossman, W A Bleyer, Gregory H. Reaman, A R Ablin, Louis Novak, Allan F. Pyesmany, Paul S. Gaynon, J Z Finklestein, V C Albo, Peter G. Steinherz |
|---|---|
| Rok vydání: | 1993 |
| Předmět: |
Adult
Male Cancer Research Pediatrics medicine.medical_specialty Adolescent medicine.medical_treatment Lymphoblastic Leukemia chemical and pharmacologic phenomena Drug Administration Schedule immune system diseases hemic and lymphatic diseases Acute lymphocytic leukemia Antineoplastic Combined Chemotherapy Protocols medicine Humans Life Tables Child Proportional Hazards Models Chemotherapy Group study business.industry Follow up studies Infant Cancer hemic and immune systems Length of Stay Precursor Cell Lymphoblastic Leukemia-Lymphoma medicine.disease Combined Modality Therapy Survival Analysis Regimen Treatment Outcome Oncology El Niño Child Preschool Female business Follow-Up Studies |
| Zdroj: | Journal of Clinical Oncology. 11:2234-2242 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.1993.11.11.2234 |
| Popis: | PURPOSE On past Childrens Cancer Group (CCG) trials, children with acute lymphoblastic leukemia and unfavorable presenting features had obtained an event-free survival (EFS) rate of no better than 50%. Following promising pilot experience, this study was conducted to determine the benefit and morbidity of two intensive experimental regimens, Reg A, based on the Berlin-Frankfurt-Münster (BFM) 1976 regimen, and Reg B, the New York regimen. PATIENTS AND METHODS Between February 1983 and November 1984, 217 eligible children with acute lymphoblastic leukemia and unfavorable presenting features were entered and randomly assigned to receive Reg A, Reg B, or Reg C, the control regimen. Assignment to Reg C was halted in November 1984 after interim analyses showed an inferior outcome. Subsequently, between November 1984 and March 1987, an additional 328 patients were randomly allocated to receive Reg A or Reg B. RESULTS The 7-year EFS rate was 63% (+/- 6%, 1 SD) for Reg A, 61% (+/- 6%) for Reg B, and 40% (+/- 6%) for Reg C (P < .006). The difference between Reg A or Reg B and Reg C remained greater than 20 percentage points for EFS at 7 years and 15 percentage points for survival. Relative to Reg C, patients on Reg A accrued 16.3 additional days of hospitalization on average and, on Reg B, 20.2 days. EFS and survival were similar on Reg A and Reg B, but Reg B required more days of parenteral therapy and greater exposure to anthracyclines and alkylating agents. CONCLUSION Both Reg A and Reg B provided a better outcome than Reg C for children with acute lymphoblastic leukemia and unfavorable presenting features. Outcomes on Reg A and Reg B were similar. Use of the more effective but more toxic regimens resulted in 78 additional hospital days per relapse prevented on Reg A and 101 days on Reg B. The current CCG trial for this population builds on Reg A. |
| Databáze: | OpenAIRE |
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