Excellent Outcomes With Reduced Frequency of Vincristine and Dexamethasone Pulses in Standard-Risk B-Lymphoblastic Leukemia: Results From Children's Oncology Group AALL0932
| Autor: | Mignon L. Loh, Johann K. Hitzler, Naomi J. Winick, Reuven J. Schore, Andrew J. Carroll, Ashley R. Lane, Brent L. Wood, Patrick A. Zweidler-McKay, Anne L. Angiolillo, Elizabeth A. Raetz, Nyla A. Heerema, Cindy Wang, Karen R. Rabin, Michael J. Borowitz, John A. Kairalla, Mary V. Relling, Meenakshi Devidas, William L. Carroll, Mylene Bassal, Kelly W. Maloney, Stephen P. Hunger |
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| Rok vydání: | 2021 |
| Předmět: |
Oncology
Male Cancer Research Vincristine medicine.medical_specialty MEDLINE Newly diagnosed Dexamethasone Standard Risk Internal medicine Precursor B-Cell Lymphoblastic Leukemia-Lymphoma Antineoplastic Combined Chemotherapy Protocols medicine Humans Child business.industry B lymphoblastic leukemia ORIGINAL REPORTS Prognosis Survival Rate Child Preschool Female business medicine.drug Follow-Up Studies |
| Zdroj: | J Clin Oncol |
| ISSN: | 1527-7755 |
| Popis: | Purpose: AALL0932 evaluated two randomized maintenance interventions to optimize disease-free survival (DFS) while reducing the burden of therapy in children with newly diagnosed NCI standard-risk (SR) B-acute lymphoblastic leukemia (B-ALL). Methods: AALL0932 enrolled 9,229 patients with B-ALL; 2,364 average-risk (AR) patients were randomly assigned (2 × 2 factorial design) at the start of maintenance therapy to vincristine/dexamethasone pulses every 4 (VCR/DEX4) or every 12 (VCR/DEX12) weeks, and a starting dose of weekly oral methotrexate of 20 mg/m2 (MTX20) or 40 mg/m2 (MTX40). Results: Five-year event-free survival and overall survival (OS) from enrollment (with 95% CIs), for all eligible and evaluable SR B-ALL patients (n = 9,226), were 92.0% (91.1% and 92.8%) and 96.8% (96.2% and 97.3%), respectively. The 5-year DFS and OS from the start of maintenance for randomly assigned AR patients were 94.6% (93.3% and 95.9%) and 98.5% (97.7% and 99.2%), respectively. The 5-year DFS and OS for patients randomly assigned to receive VCR/DEX4 (n = 1,186) versus VCR/DEX12 (n = 1,178) were 94.1% (92.2% and 96.0%) and 98.3% (97.2% and 99.4%) v 95.1% (93.3% and 96.9%) and 98.6% (97.7% and 99.6%), respectively ( P = .86 and .69). The 5-year DFS and OS for AR patients randomly assigned to receive MTX20 versus MTX40 were 95.1% (93.3% and 96.8%) and 98.8% (97.9% and 99.7%) v 94.2% (92.2% and 96.1%) and 98.1% (97.0% and 99.2%), respectively ( P = .92 and .89). Conclusions: The 0NCI-SR AR B-ALL who received VCR/DEX12 had outstanding outcomes despite receiving one third of the vincristine/dexamethasone pulses previously used as standard of care on Children's Oncology Group (COG) trials. The higher starting dose of MTX of 40 mg/m2/week did not improve outcomes when compared with 20 mg/m2/week. The decreased frequency of vincristine/dexamethasone pulses has been incorporated into frontline COG B-ALL trials to decrease the burden of therapy for patients and their families. |
| Databáze: | OpenAIRE |
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