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SHR Neuro Cancer Cardio Lipid Metab Microb
Moricke, A; Reiter, A; Zimmermann, M; Gadner, H; Stanulla, M; Dordelmann, M; Loning, L; Beier, R; Ludwig, WD; Ratei, R; Harbott, J; Boos, J; Mann, G; Niggli, F; Feldges, A; Henze, G; Welte, K; Beck, JD; Klingebiel, T; Niemeyer, C; Zintl, F; Bode, U; Urban, C; Wehinger, H; Niethammer, D; Riehm, H; Schrappe, M.
Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95.
Blood. 2008; 111(9): 4477-4489.
Doi: 10.1182/blood-2007-09-112920
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- Co-authors Med Uni Graz
- Urban Ernst-Christian
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- Abstract:
- The trial ALL-BFM 95 for treatment of childhood acute lymphoblastic leukemia was designed to reduce acute and long-term toxicity in selected patient groups with favorable prognosis and to improve outcome in poor-risk groups by treatment intensification. These aims were pursued through a stratification strategy using white blood cell count, age, immunophenotype, treatment response, and unfavorable genetic aberrations providing an excellent discrimination of risk groups. Estimated 6-year event-free survival (6y-pEFS) for all 2169 patients was 79.6% (+/- 0.9%). The large standard-risk (SR) group (35% of patients) achieved an excellent 6y-EFS of 89.5% (+/- 1.1%) despite significant reduction of anthracyclines. In the medium-risk (MR) group (53% of patients), 6y-pEFS was 79.7% (+/- 1.2%); no improvement was accomplished by the randomized use of additional intermediate-dose cytarabine after consolidation. Omission of preventive cranial irradiation in non-T-ALL MR patients was possible without significant reduction of EFS, although the incidence of central nervous system relapses increased. In the high-risk (HR) group (12% of patients), intensification of consolidation/reinduction treatment led to considerable improvement over the previous ALL-BFM trials yielding a 6y-pEFS of 49.2% (+/- 3.2%). Compared without previous trial ALL-BFM 90, consistently favorable results in non-HR patients were achieved with significant treatment reduction in the majority of these patients.
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