Toxicity and efficacy of intensive chemotherapy for children with acute lymphoblastic leukemia (ALL) after first bone marrow or extramedullary relapse

Pediatric Blood & Cancer
Blythe ThomsonDouglas S Hawkins

Abstract

Approximately 25% of children newly diagnosed with acute lymphoblastic leukemia (ALL) will eventually experience leukemic relapse, with bone marrow being the most common site of recurrence. The ability to achieve a durable second remission is complicated by toxicity and resistant disease. We report a novel combination of chemotherapy for relapsed pediatric ALL. Thirty pediatric patients with relapsed medullary (n = 18) and extra-medullary (n = 12) ALL were enrolled at three pediatric institutions. Following receipt of induction and the first Block A and Block B of intensification, each patient was evaluated for toxicity, efficacy in achieving remission, and long-term survival. Additionally, minimal residual disease (MRD) detection by multidimensional flow cytometry (MDF) was performed. During induction, the major non-hematopoeitic toxicities were mucositis (30% of patients) and bacteremia (50% of patients). Two patients (7%) died of toxicity during induction. Toxicity during intensification Block 1A and 1B was markedly reduced. Eight-nine percent of patients with marrow disease achieved a remission following induction and intensification. The event-free survival (EFS) for all patients at 2 and 4 years were 60% (95% CI: 42-78%) ...Continue Reading

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Citations

Jan 6, 2006·Drug Metabolism Reviews·Jing ZhangYi-Zhun Zhu
Jun 25, 2009·Seminars in Hematology·L Charles BaileySusan R Rheingold
Sep 2, 2008·The Lancet Oncology·L Charles BaileyNancy J Bunin
Sep 23, 2008·European Journal of Cancer : Official Journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)·Carine DomenechYves Bertrand
Nov 22, 2011·Pediatric Blood & Cancer·Sarah AlexanderLillian Sung
Aug 20, 2008·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Elizabeth A RaetzWilliam L Carroll
Dec 21, 2006·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Ulla M Saarinen-PihkalaGöran Gustafsson

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