Co-operative study group for childhood acute lymphoblastic leukemia (COALL): long-term follow-up of trials 82, 85, 89 and 92

Abstract

Co-operative study group for childhood acute lymphoblastic leukemia (COALL): longterm follow-up of trials 82, 85, 89 and 92DO Harms, GE Janka-Schaub on behalf of the COALL Study Group Children's University Hospital, Department of Hematology and Oncology, Hamburg, GermanyThe German Co-operative Study Group COALL for treatment of acute lymphoblastic leukemia (ALL) in childhood started the first trial in 1980. This report gives an overview of the long-term results of the four consecutive studies COALL-82, COALL-85, COALL-89 and COALL-92. Besides improvement in long-term survival major objectives were reduction of treatment-related toxicity by transferring asparaginase (ASP) from induction therapy to intensive phase and omitting CNS irradiation by stepwise increase of the initial white blood count (WBC) up to 50 × 10 9 /l (exception T-ALL) as criterion for irradiation. In study COALL-85 in high risk patients slow vs rapid rotational treatment was randomized. In study COALL-92 initial response to daunorubicin (DNR) as a 1-h vs 24-h infusion and its prognostic value was investigated. Furthermore, 6-mercaptopurine (6-MP) and 6-thioguanine (6-TG) were randomized in maintenance treatment. In total, 1191 eligible patients were enrolled. Induction treatment without ASP has been shown to be as effective and less hazardous than the former four-drug induction. CNS control could be obtained in most without cranial irradiation (CNS relapse-free survival Ͼ95%). The leukemic cell kill with a 24-h DNR infusion was equivalent to that of a 1-h infusion. DNR response was of less prognostic significance than prednisone response. The rapid rotation regimen failed to improve outcome as well as 6-TG in maintenance treatment. However, intensification of systemic treatment resulted in an increase in overall event-free survival (EFS) to approximately 80% which is comparable to other groups. Leukemia (2000) 14, 2234-2239.

International childhood Acute Lymphoblastic Leukemia workshop: Sausalito, CA, 30 November–1 December 2000

“…[5][6][7][8][9][10][11][12][13][14][15][16] It was noted that even though no new antileukemic agents were introduced in the study period, a steady improvement in event-free survival was noted for all groups and institutions. This success was mainly due to optimization of the use of existing agents.…”

“…The intent was to identify effective treatment for certain well-defined subsets of patients. This unprecedented effort resulted in 12 informative articles published together in the December 2000 issue of Leukemia, [5][6][7][8][9][10][11][12][13][14][15][16] providing valuable clues to advance the cure rate in future trials.…”

Prognostic Significance of Survivin in Pediatric Acute Lymphoblastic Leukemia

“…Despite the very good overall prognosis of children with acute lymphoblastic leukemia (ALL), whose long-term survival is now 70-80%, treatment of relapsed disease remains a challenge [19]. Early identification of patients with a poor prognosis allows for the prospective evaluation of new consolidating treatment elements at an early stage of the disease.…”

Cooperative study group for childhood acute lymphoblastic leukaemia (COALL): long-term results of trials 82,85,89,92 and 97

“…The aim of the first three trials was to define risk criteria of acute lymphoblastic leukaemia (ALL) of childhood by combining the first known risk factor, initial white blood cell count (WBC), with the variables age at diagnosis, immunophenotype and chromosomal rearrangements to establish and optimize a risk-adapted treatment approach. [1][2][3] In COALL 92, the in vitro drug sensitivity, which was determined using the methyl-thiazol-tetrazolium assay, was prospectively evaluated and implemented in COALL 97 as a new risk variable. 4 COALL 92 also focussed on the mode of administration of anthracyclines and on the drug of choice in maintenance therapy.…”