Favorable response to maintenance therapy of second or subsequent remissions in childhood acute lymphocytic leukemia

Kimball, J C; Herson, Jay; Sullivan, Margaret P.

doi:10.1002/1097-0142(19800901)46:5<1093::aid-cncr2820460503>3.0.co;2-w

Cited by 13 publications

(1 citation statement)

References 20 publications

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“…The majority of secondary maintenance regimens tried thus far have produced median durations of remission less than 6 months. Recently, a regimen containing MTX, Daunomycin, 6-mercaptopurine, PDN, and VCR produced a median duration of remission of 35 weeks [7]. Rivera at St. Jude's obtained a 30 weeks' median duration of remission utilizing VM-26 and ARA-C intensification followed by VCR and cyclophosphamide maintenance [ 161.…”

Section: Discussionmentioning

confidence: 99%

Prolonged second remissions in childhood acute lymphocytic leukemia: A report from the childrens cancer study group

Baum

Nachman²,

Ramsay³

et al. 1983

Med. Pediatr. Oncol.

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To date, median duration of second and subsequent remissions in childhood acute lymphocytic leukemia (ALL) has been short, with most studies reporting median remission duration less than 6 months. In May 1979, the Childrens Cancer Study Group (CCSG) undertook a pilot study to assess the efficacy of a vincristine, methotrexate, and L-asparaginase regimen (modified Capizzi) for maintenance in children with ALL in second or subsequent remission. Thirty patients were treated with this maintenance regimen. By life table analysis, predicted median duration of hematologic remission was 57 weeks. Ten patients (33%) were in continuous hematologic remission at 1 year and three (10%) continue in remission greater than 2 years from maintenance onset. Major toxicity included leukoencephalopathy in four patients, three of whom had experienced at least one central nervous system relapse prior to study entry. Allergic reactions to Escherichia coli L-asparaginase were common. Nine of 30 patients experienced at least one CNS relapse during therapy. We conclude that a modified Capizzi regimen is the most effective regimen reported to date for maintaining second and subsequent remission in childhood ALL. CCSG is currently utilizing this regimen in an ongoing open study.

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Section: Discussionmentioning

confidence: 99%

Prolonged second remissions in childhood acute lymphocytic leukemia: A report from the childrens cancer study group

Baum

Nachman²,

Ramsay³

et al. 1983

Med. Pediatr. Oncol.

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Remission induction and continuation therapy in children with their first relapse of acute lymphoid leukemia. A pediatric oncology group study

Culbert

Shuster

Land

et al. 1991

Cancer

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Between January 1979 and April 1983, 113 children undergoing their first relapse of acute lymphoid leukemia (ALL) at any site were registered in Pediatric Oncology Group study 7834; 98 were eligible and evaluable. In addition to radiotherapy administered to sites of local relapse, induction consisted of vincristine, doxorubicin, and prednisone (VAP) chemotherapy. Continuation therapy consisted of triple-drug intrathecal therapy and regimens of 6-thioguanine and cytarabine alternating with vincristine, prednisone, cyclophosphamide, and cytarabine. Randomization in continuation was between VAP pulses or no pulse, regardless of the site of relapse. This report provides long-term follow-up of these patients. Thirty-two of 39 children with bone marrow involvement achieved a complete response (CR). Only one of these is alive in an unmaintained remission, a child who did not have an initial CR. Thirty-four of 36 evaluable children with central nervous system involvement as the site of relapse achieved CR. Of these ten are alive; eight are in continuing CR. Nineteen of 20 boys with testicular relapse achieved CR. Of these, 14 are still alive and not receiving therapy, although only one half received treatment in compliance with the protocol described. These results illustrate the possibility of cure of patients who have relapsed with ALL when it is (1) confined to a meningeal or gonadal site and (2) treated vigorously with radiotherapy and a new regimen of systemic chemotherapy. The results reconfirm the need to prevent an initial relapse at any site.

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Modified Capizzi maintenance regimen in children with relapsed acute lymphoblastic leukaemia

Pinkerton

Mills

Chessells

1986

Med. Pediatr. Oncol.

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Improved survival of children with acute lymphoblastic leukaemia who relapse during therapy has been reported using the Capizzi maintenance regimen. We have treated ten such patients, without histocompatible donors, with this regimen, which consisted of fortnightly doses of vincristine (1.5 mg/m2) and an escalating dose of intravenous methotrexate (90-470 mg/m2) followed 24 hours later by asparaginase (15,000 units). Remission of disease had been successfully achieved in all patients using conventional therapy prior to the start of maintenance treatment. Cerebrospinal fluid concentrations of methotrexate were estimated serially in several patients but remained relatively low despite dose escalation. It appears that additional intrathecal chemotherapy is therefore necessary. Treatment was generally well tolerated but there is concern about the incidence of neurotoxicity in patients who had previously received cranial irradiation and intensive intrathecal therapy. The median duration of bone marrow remission was only 35 weeks (range 18-50). Two patients who had not been receiving IT therapy had early isolated CNS relapses. In conclusion, it appears that contrary to early expectations this treatment approach is unlikly to offer a significantly better outlook for these patients, in whom the chance of early marrow relapse remains high.

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Favorable response to maintenance therapy of second or subsequent remissions in childhood acute lymphocytic leukemia

Cited by 13 publications

References 20 publications

Prolonged second remissions in childhood acute lymphocytic leukemia: A report from the childrens cancer study group

Prolonged second remissions in childhood acute lymphocytic leukemia: A report from the childrens cancer study group

Remission induction and continuation therapy in children with their first relapse of acute lymphoid leukemia. A pediatric oncology group study

Modified Capizzi maintenance regimen in children with relapsed acute lymphoblastic leukaemia

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