Long-term results of St Jude Total Therapy Studies 11, 12, 13A, 13B, and 14 for childhood acute lymphoblastic leukemia

Abstract

We analyzed the long-term outcome of 1011 patients treated in five successive clinical trials (Total Therapy Studies 11, 12, 13A, 13B and 14) between 1984 and 1999. The event-free survival improved significantly (p=0.003) from the first two trials conducted in the 1980s to the three more recent trials conducted in the 1990s. Approximately 75% of patients treated in the 1980s and 80% in the 1990s were cured. Early intensive triple intrathecal therapy, together with more effective systemic therapy, including consolidation and reinduction treatment (Studies 13A and 13B) as well as dexamethasone (Study 13A), resulted in a very low rate of isolated central-nervous-system relapse rate (<2%), despite the reduced use of cranial irradiation. Factors consistently associated with treatment outcome were age, leukocyte count, immunophenotype, DNA index, and minimal residual disease level after remission induction treatment. Because of concerns about therapy-related secondary myeloid leukemia and brain tumors, in our current trials we reserve the use of etoposide for patients with refractory or relapsed leukemia undergoing hematopoietic stem cell transplantation, and cranial irradiation for those with CNS relapse. The next main challenge is to further increase cure rates while improving quality of life for all patients.

Implementation of an intensive risk‐stratified treatment protocol for children and adolescents with acute lymphoblastic leukemia in Lebanon

“…The proportion of patients in our series with T-ALL (13.5%) was comparable to figures reported from studies worldwide including the BFM 95 study (13.3%) [8]. This percentage was also comparable to 13.9%-17.4% of children with T-ALL reported in the last five studies at St Jude Children's Research Hospital [19]. In studies of children with ALL in low-/middle-income countries, the incidence of T-cell ALL ranged from 11.5% to 26.6% [20][21][22].…”

Detection of CD10, CD34 and their combined expression on Childhood Acute Lymphoblastic Leukemia and the association with clinical outcome in Indonesia

“…This result is similar to our previous study [24]. Compared to studies in high income and low-income countries our finding is relatively high for T-lineage ALL [25][26][27][28][29][30][31][32][33][34][35]. Expression of CD10 and CD34 also varies in different studies ( Table 1).…”

Favorable outcome in infants with AML after intensive first- and second-line treatment: an AML-BFM study group report

“…30 In view of these considerations, the aim should be to optimize treatment for infants with AML, applying the most effective treatment with the lowest side effects. 25,31,32 This implies to use HSCT in CR1 only in selected patients in whom a clear benefit can be expected (further analyses with higher number of patients are needed to define this group). In addition, in future AML-BFM studies, CNS irradiation will be substituted by triple-intrathecal therapy.…”