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Titolo:
Six months of maintenance chemotherapy after intensified treatment for acute lymphoblastic leukemia of childhood
Autore:
Toyoda, Y; Manabe, A; Tsuchida, M; Hanada, R; Ikuta, K; Okimoto, Y; Ohara, A; Ohkawa, Y; Mori, T; Ishimoto, K; Sato, T; Kaneko, T; Maeda, M; Koike, K; Shitara, T; Hoshi, Y; Hosoya, R; Tsunematsu, Y; Bessho, F; Nakazawa, S; Saito, T;
Indirizzi:
Kanagawa Childrens Med Ctr, Dept Oncol, Minami Ku, Yokohama, Kanagawa 2328555, Japan Kanagawa Childrens Med Ctr Yokohama Kanagawa Japan 2328555 2328555, Japan Yokohama City Univ, Sch Med, Dept Pediat, Yokohama, Kanagawa 232, Japan Yokohama City Univ Yokohama Kanagawa Japan 232 ohama, Kanagawa 232, Japan Univ Tokyo, Dept Pediat Hematol Oncol, Inst Med Sci, Tokyo, Japan Univ Tokyo Tokyo Japan Pediat Hematol Oncol, Inst Med Sci, Tokyo, Japan Tokyo Med & Dent Univ, Sch Med, Dept Pediat, Tokyo 113, Japan Tokyo Med & Dent Univ Tokyo Japan 113 Med, Dept Pediat, Tokyo 113, Japan Keio Univ, Sch Med, Tokyo 108, Japan Keio Univ Tokyo Japan 108Keio Univ, Sch Med, Tokyo 108, Japan Juntendo Univ, Sch Med, Tokyo 113, Japan Juntendo Univ Tokyo Japan 113Juntendo Univ, Sch Med, Tokyo 113, Japan St Lukes Int Hosp, Nippon Med Sch, Tokyo, Japan St Lukes Int Hosp Tokyo Japan es Int Hosp, Nippon Med Sch, Tokyo, Japan Teikyo Univ, Sch Med, Tokyo 173, Japan Teikyo Univ Tokyo Japan 173Teikyo Univ, Sch Med, Tokyo 173, Japan Tokyo Metropolitan Kiyose Childrens Hosp, Dept Hematol Oncol, Tokyo, JapanTokyo Metropolitan Kiyose Childrens Hosp Tokyo Japan ncol, Tokyo, Japan Natl Childrens Hosp, Dept Hematol, Tokyo, Japan Natl Childrens Hosp Tokyo Japan ldrens Hosp, Dept Hematol, Tokyo, Japan Natl Childrens Med Res Ctr, Tokyo 154, Japan Natl Childrens Med Res Ctr Tokyo Japan 154 Med Res Ctr, Tokyo 154, Japan Ibaraki Childrens Hosp, Dept Pediat, Mito, Ibaraki, Japan Ibaraki Childrens Hosp Mito Ibaraki Japan t Pediat, Mito, Ibaraki, Japan Saitama Childrens Med Ctr, Dept Hematol Oncol, Iwatsuki, Saitama, Japan Saitama Childrens Med Ctr Iwatsuki Saitama Japan watsuki, Saitama, Japan Chiba Childrens Hosp, Dept Hematol Oncol, Chiba, Japan Chiba Childrens Hosp Chiba Japan Hosp, Dept Hematol Oncol, Chiba, Japan Chiba Univ, Sch Med, Dept Pediat, Chiba, Japan Chiba Univ Chiba JapanChiba Univ, Sch Med, Dept Pediat, Chiba, Japan Shinshu Univ, Sch Med, Dept Pediat, Matsumoto, Nagano 390, Japan Shinshu Univ Matsumoto Nagano Japan 390 iat, Matsumoto, Nagano 390, Japan Gunma Childrens Med Ctr, Dept Hematol Oncol, Maebashi, Gumma, Japan Gunma Childrens Med Ctr Maebashi Gumma Japan col, Maebashi, Gumma, Japan Yamanashi Med Univ, Dept Pediat, Kohfu, Japan Yamanashi Med Univ Kohfu Japan ashi Med Univ, Dept Pediat, Kohfu, Japan
Titolo Testata:
JOURNAL OF CLINICAL ONCOLOGY
fascicolo: 7, volume: 18, anno: 2000,
pagine: 1508 - 1516
SICI:
0732-183X(200004)18:7<1508:SMOMCA>2.0.ZU;2-R
Fonte:
ISI
Lingua:
ENG
Soggetto:
CHILDRENS-CANCER-GROUP; COLONY-STIMULATING FACTOR; PROGNOSTIC-SIGNIFICANCE; INDUCTION CHEMOTHERAPY; PRESENTING FEATURES; PHASE-III; THERAPY; TRIAL; ACCUMULATION; LINEAGE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
31
Recensione:
Indirizzi per estratti:
Indirizzo: Toyoda, Y Kanagawa Childrens Med Ctr, Dept Oncol, Minami Ku, 2-138-4 Mutsukawa, Yokohama, Kanagawa 2328555, Japan Kanagawa Childrens Med Ctr 2-138-4 Mutsukawa Yokohama Kanagawa Japan 2328555
Citazione:
Y. Toyoda et al., "Six months of maintenance chemotherapy after intensified treatment for acute lymphoblastic leukemia of childhood", J CL ONCOL, 18(7), 2000, pp. 1508-1516

Abstract

Purpose: We postulated that intensification of chemotherapy immediately after remission induction might reduce the leukemic cell burden sufficiently to allow an abbreviated period of antimetabolite therapy. Patients and Methods: Three hundred forty-seven children (ages 1 to 15 years) with previously untreated acute lymphoblastic leukemia (ALL) were enrolled onto the Tokyo L92-13 study, which excluded patients with mature B-cellALL and patients less than 1 year old. One hundred twenty-four patients were classified as standard risk, 122 as high risk, and 101 as extremely highrisk, according to age, peripheral-blood leukocyte count selected genetic abnormalities, and immunophenotype. All subjects received four drugs for remission induction, followed by a risk-directed multidrug intensification phase and therapy for presymptomatic leukemia in the CNS. Maintenance chemotherapy with oral mercaptopurine and methotrexate was administered for 6 months, with all treatment stopped by 1 year after diagnosis. Results: The mean (+/- SD) event-free survival (EFS) and overall survival rates far all patients were 59.5% +/- 3.4% and 81.5% +/- 2.2%, respectively, at 5.5 years after diagnosis. EFS rates by risk category were similar (60.2% +/- 6.0% for standard risk, 57.7% +/- 5.6% for high risk, and 62.5% +/-5.7% for extremely high risk), whereas overall survival rates differed significantly (91.2% +/- 2.7%, 80.0% +/- 4.1%, and 72.1% +/- 4.5%, respectively, P < .0001 by the lag-rank test). There were 107 relapses. Eighty-five (79.4%) of these 107 patients achieved second complete remissions, with subsequent EFS rates of 61.5% +/- 7.9% (standard risk), 42.6% +/- 8.1% (high risk), and 9.6% +/- 6.4% (extremely high risk). Of the five risk factors analyzed, only the response to prednisolone monotherapy among extremely high-risk patients proved important. Conclusion: Early treatment intensification did nat compensate for a truncated phase of maintenance chemotherapy in children with standard or high-risk ALL, However, 6 months of antimetabolite treatment seemed adequate for extremely high-risk patients who were good responders to prednisolone and received intensified chemotherapy that included high-dose cytarabine early inthe clinical course. (C) 2000 by American Society of Clinical Oncology.

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Documento generato il 19/01/20 alle ore 09:17:06