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Abstract
Background:
The bone marrow (BM) findingd on day 7 of induction chemotherapy is one of major prognostic factors for patients with acute lymphoblastic leukemia (ALL). M3 marrow (blast ＞25% on BM examination) on day 7 is associated with lower survival rates, compared with the M1 (blast ＜5%) or M2 (blast 5∼25%) marrow. Herein, we analyzed the effect of augmented post-induction chemotherapy in patients who have high-risk ALL with M3 marrow on the day 7 BM examination.
Methods:
We analyzed the patients who were diagnosed with high-risk ALL and they received modified Children's Cancer Group (CCG)-1882 induction chemotherapy between January 1996 and October 2005 at Seoul National University Children's Hospital. The patients with M1 or M2 marrow on day 7 were treated with modified CCG-1882A/B chemotherapy from consolidation, and the patients with M3 marrow were treated with modified CCG-1882C chemotherapy.
Results:
A total of 44 patients (29 with modified CCG-1882A/B and 15 with modified CCG-1882C) were analyzed. The overall survival (OS) and 5-year event-free survival (EFS) were 86.2% and 81.9%, respectively. The OS of the patients who were treated with the modified CCG-1882A/B protocol (88.9%) was not different from that of the patients who were treated with the modified CCG-1882C protocol (80.0%) (P=0.3256). Also, there was no statistical difference in the 5-year EFS of both groups (85.4% vs 72.7%, respectively, P=0.2117).
Conclusions:
There was no difference of survival between the patients with M1/M2 marrow on the day 7 BM examination and those with M3 marrow after augmented post-induction chemotherapy for the patient with high-risk ALL. We suggest that the poor prognosis of high-risk ALL patients with a poor initial response could be overcome by augmented post-induction chemotherapy.
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Fig. 2
Overall survival (A) and event-free survival (B) in both groups of post-induction treatment protocols. There was no statistical difference in overall survival (P=0.3256) and event-free survival (P=0.2117) of both groups.
Table 1.
Original (A) and modified (B) CCG-1882 induction chemotherapy protocol
| (A) | |
| Original CCG-1882 induction chemotherapy protocol | |
| Prednisolone (40mg/m2, oral) | Days 0~27, then tapered over 10 days |
| Vincristine (1.5mg/m2, IV) (max. dose: 2mg) | Days 0, 7, 14, 21 |
| L-asparaginase (6,000IU/m2, IM) | Three times per week, total 9 doses |
| Daunomycin (25mg/m2, IV) | Days 0, 7, 14, 21 |
| Cytarabine (IT, age-adjusted dose∗) | Day 0 |
| Methotrexate (IT, age-adjusted dose†) | Day 14, 28 |
| (B) | |
| Modified CCG-1882 induction chemotherapy protocol | |
| Prednisolone (60mg/m2, oral) | Days 0~27, then tapered over 14 days |
| Vincristine (1.5mg/m2, IV) (max. dose: 2mg) | Days 0, 7, 14, 21 |
| L-asparaginase (6,000IU/m2, IM) | Three times per week, total 9 doses |
| Daunomycin (25mg/m2, IV) (if ANC ≥500/uL and platelet count ≥50,000/uL on day 14 and 21) | Days 0, 7, 14, 21 |
| Cytarabine (IT, age-adjusted dose∗) | Day 0 |
| Methotrexate (IT, age-adjusted dose†) | Day 7, 28 |
Table 2.
Modified CCG-1882A/B and CCG-1882C post-induction chemotherapy protocol
Abbreviations: CCG, Children's Cancer Group; IV, intravenously; SC, subcutaneously; IM, intramuscularly; IT, intrathecally; PO, orally; Triple therapy, cytarabine+hydrocortisone+methotrexate; ANC, absolute neutrophil count. ∗Cranial (1,800cGy) or craniospinal (2,400+600)cGy radiotherapy was done in the consolidation stage.
Table 3.
Characteristics of both treatment groups
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