Evaluation of intensification and maintenance programs in the treatment of acute lymphoblastic leukemia

Abstract

This cooperative prospective study was designed to answer the following questions in cases with acute lymphoblastic leukemia induced to achieve complete remission with the combination of vincristine and prednisone (if by day 29 the bone marrow was not M1, daunorubicin was added to the former regimen) and who received preventive CNS therapy with 2400 rad of cobalt-60 to craniocervical region and simultaneously intrathecal methotrexate and dexamethasone: 1) Is a short intensification with cytosine-arabinoside and cyclophosphamide immediately after complete remission useful? 2) Does the use of weekly doses of 6-mercaptopurine and methotrexate have the same maintenance effect as daily 6-mercaptopurine and twice weekly methotrexate? and 3) Do further 3 month-doses of intrathecal methotrexate and dexamethasone help to decrease still more the incidence of meningeal leukemia? From October 1972 to December 1975, 473 previously untreated patients entered this study and 465 (390 children and 75 adults) are evaluated in this paper. Of them, 373 (80%) achieved complete remission (children 84% and adults 61%). Out of 109 "high risk" children (one or more of the following characteristics at diagnosis: marked organomegaly, mediastinal widening, leukocytosis above 50000/ mm3 and CNS involvement) 83 (76%) and out of 281 "standard risk'' children (all the others) 244 (87%) achieved complete remission. The median duration of complete remission according to different prognostic factors was as follows: "high risk" children 10 months, adults 24 months and "standard risk" children 25 months. Duration of complete remission of the "standard risk" children in relation to with or without intensification, daily or weekly maintenance and additional intrathecal therapy or none, showed no significant difference; however, those who received intensification, daily maintenance and further intrathecal therapy behaved slightly better. Median survival for all the cases of this study was as follows: adults 10 months, "high risk" children 12 months and "standard risk" children 26. months. At 36 months, 13% of "high risk" children, 25% of adults and 39% of "standard risk" children are still alive. We conclude that the variables studied in this protocol did not show significant extension of complete remission, however the sum of them seems to offer some advantage. Moreover, what appears clear is the importance of prognostic factors which must be taken into account in future studies.

Long‐term remission of children with relapsed and secondary anaplastic large cell non‐Hodgkin lymphoma (ALCL) following treatment with pulsed dexamethasone and low dose etoposide

“…The explanation for the effect of low‐dose maintenance therapy must remain speculative at this point. However, prolonged exposure to low‐dose chemotherapy is well established as a crucial element of therapy of ALL, for example 17, and anti‐angiogenetic effects have been suggested to occur after prolonged exposure to low‐dose chemotherapy 18. Furthermore, a number of drugs are known to target different cellular and molecular mechanisms at different dosages.…”

International Society of Paediatric Oncology (SIOP) Global Mapping Programme: Latin American Society of Pediatric Oncology (SLAOP) country‐level report

“…Argentina has been providing public support to care for children and adolescents with cancer regardless the insurance status since treatment for childhood cancer became available in the 1970s. 11 There is a National Cancer Institute (NCI) that sets policy, but is not involved in direct patient care. The NCI launched an NPCCP and a National Cancer Registry and is leading an effort to stratify treatment units across the country.…”

Chemoimmunotherapy with levamisole in acute lymphoblastic leukemia

“…A clinical trial of levamisole in advanced human breast cancer showed a significant prolongation of the provements .3,5+ 1920* [25][26][27] 0008-543X/81/1000/1500 $0.90 0 American Cancer Society…”