Low-dose oral etoposide-based induction regimen for children with acute lymphoblastic leukemia in first bone marrow relapse

Leukemia
N HijiyaC H Pui

Abstract

We evaluated the clinical response to low-dose etoposide in relapsed acute lymphoblastic leukemia (ALL). Of the 45 patients with ALL in first bone marrow relapse enrolled on the ALL R15 protocol, 44 had received epipodophyllotoxins during frontline therapy. In the first week of remission induction therapy, patients received etoposide (50 mg/m(2) per day) administered orally as a single agent once or twice daily. On Day 8, patients started to receive dexamethasone, vincristine, and L-asparaginase. Etoposide was administered until Day 22. Two courses of consolidation therapy were followed by continuation therapy or hematopoietic stem cell transplantation. After 7 days of single-agent etoposide treatment, peripheral blast cell counts (P=0.013) and percentages of bone marrow blasts (P=0.016) were significantly reduced. In all, 38 (84.4%) attained second remission. Only time to relapse was significantly associated with outcome (P=0.025): the 5-year event-free survival estimates (+/-se) were 52.0+/-9.6% for those with late relapse and 20.0+/-8.0% for those with early relapse. We conclude that low-dose etoposide administered orally has a cytoreductive effect in relapsed ALL.

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Citations

Jan 17, 2012·Journal of Pediatric Hematology/oncology·Ulla M Saarinen-PihkalaMerja Möttönen
Apr 30, 2013·Indian Journal of Pediatrics·Sandeep Jain, Gauri Kapoor
Aug 23, 2005·Cancer Chemotherapy and Biological Response Modifiers·Peter H Wiernik
Dec 21, 2006·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Ulla M Saarinen-PihkalaGöran Gustafsson
Jun 18, 2019·Pediatric Blood & Cancer·Raja Pramanik, Sameer Bakhshi
Jun 28, 2016·Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology·Yin Ting CheungKevin R Krull

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