Journal
BLOOD
Volume 111, Issue 5, Pages 2548-2555Publisher
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2007-02-070342
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Funding
- NCI NIH HHS [CA 30969, CA 13539, U10 CA098543, U10 CA 98543] Funding Source: Medline
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Longer and more intensive postinduction intensification (PII) improved the outcome of children and adolescents with higher risk acute lymphoblastic leukemia (ALL) and a slow marrow response to induction therapy. In the Children's Cancer Group study (CCG-1961), we tested longer versus more intensive PII, using a 2 x 2 factorial design for children with higher risk ALL and a rapid marrow response to induction therapy. Between November 1996 and May 2002, 2078 children and adolescents with newly diagnosed ALL (11 to 9 years old with white a blood count 50 000/mm(3) or more, or 10 years of age or older with any white blood count) were enrolled. After induction, 1299 patients with marrow blasts less than or equal to 25% on day 7 of induction (rapid early responders) were randomized to standard or longer duration (n = 651 + 648) and standard or increased intensity (n = 649 + 650) PII. Stronger intensity PII improved eventfree survival (81% vs 72%, P <.001) and survival (89% vs 83%, P =.003) at 5 years. Differences were most apparent after 2 years from diagnosis. Longer duration PII provided no benefit. Stronger intensity but not prolonged duration PII improved outcome for patients with higher-risk ALL. This study is registered at http://clinicaltrials.gov as NCT00002812.
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