Early intensification of intrathecal chemotherapy virtually eliminates central nervous system relapse in children with acute lymphoblastic leukemia

Ching Hon Pui, Hazem H. Mahmoud, Gaston K. Rivera, Michael L. Hancock, John T. Sandlund, Frederick G. Behm, David R. Head, Mary V. Relling, Raul C. Ribeiro, Jeffrey E. Rubnitz, Larry E. Kun, William E. Evans

Research output: Contribution to journalArticle

170 Citations (Scopus)

Abstract

Central nervous system (CNS) relapse has been an obstacle to uniformly successful treatment of childhood acute lymphoblastic leukemia (ALL) for many years. We therefore intensified intrathecal chemotherapy (simultaneously administered methotrexate, hydrocortisone, and cytarabine) for 165 consecutive children with newly diagnosed ALL enrolled in Total Therapy Study XIIIA from December 1991 to August 1994. The 64 patients (39%) who had 1 or more blast cells in cytocentrifuged preparations of cerebrospinal fluid at diagnosis, with or without associated higher-risk features, received additional doses of intrathecal chemotherapy during remission induction and the first year of continuation treatment. Patients with higher-risk leukemia, regardless of cerebrospinal fluid findings, also received additional doses of intrathecal chemotherapy during the first year of continuation treatment. Cranial irradiation was reserved for patients with higher-risk leukemia (22% of the total). The 5-year cumulative risk of an isolated CNS relapse among all 165 patients was 1.2% (95% confidence interval, 0% to 2.9%), whereas that of any CNS relapse was 3.2% (0.4% to 6.0%). The probability of surviving for 5 years without an adverse event of any type was 80.2% ± 9.2% (SE). Our results suggest that early intensification of intrathecal chemotherapy will reduce the risk of CNS relapse to a very low level in children with ALL, securing a higher event-free survival rate overall.

Original languageEnglish (US)
Pages (from-to)411-415
Number of pages5
JournalBlood
Volume92
Issue number2
StatePublished - Jul 15 1998

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Chemotherapy
Neurology
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Central Nervous System
Recurrence
Drug Therapy
Cerebrospinal fluid
Cerebrospinal Fluid
Leukemia
Cranial Irradiation
Remission Induction
Cytarabine
Therapeutics
Methotrexate
Disease-Free Survival
Hydrocortisone
Survival Rate
Irradiation
Confidence Intervals

ASJC Scopus subject areas

  • Hematology

Cite this

Pui, C. H., Mahmoud, H. H., Rivera, G. K., Hancock, M. L., Sandlund, J. T., Behm, F. G., ... Evans, W. E. (1998). Early intensification of intrathecal chemotherapy virtually eliminates central nervous system relapse in children with acute lymphoblastic leukemia. Blood, 92(2), 411-415.

Early intensification of intrathecal chemotherapy virtually eliminates central nervous system relapse in children with acute lymphoblastic leukemia. / Pui, Ching Hon; Mahmoud, Hazem H.; Rivera, Gaston K.; Hancock, Michael L.; Sandlund, John T.; Behm, Frederick G.; Head, David R.; Relling, Mary V.; Ribeiro, Raul C.; Rubnitz, Jeffrey E.; Kun, Larry E.; Evans, William E.

In: Blood, Vol. 92, No. 2, 15.07.1998, p. 411-415.

Research output: Contribution to journalArticle

Pui, CH, Mahmoud, HH, Rivera, GK, Hancock, ML, Sandlund, JT, Behm, FG, Head, DR, Relling, MV, Ribeiro, RC, Rubnitz, JE, Kun, LE & Evans, WE 1998, 'Early intensification of intrathecal chemotherapy virtually eliminates central nervous system relapse in children with acute lymphoblastic leukemia', Blood, vol. 92, no. 2, pp. 411-415.
Pui, Ching Hon ; Mahmoud, Hazem H. ; Rivera, Gaston K. ; Hancock, Michael L. ; Sandlund, John T. ; Behm, Frederick G. ; Head, David R. ; Relling, Mary V. ; Ribeiro, Raul C. ; Rubnitz, Jeffrey E. ; Kun, Larry E. ; Evans, William E. / Early intensification of intrathecal chemotherapy virtually eliminates central nervous system relapse in children with acute lymphoblastic leukemia. In: Blood. 1998 ; Vol. 92, No. 2. pp. 411-415.
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abstract = "Central nervous system (CNS) relapse has been an obstacle to uniformly successful treatment of childhood acute lymphoblastic leukemia (ALL) for many years. We therefore intensified intrathecal chemotherapy (simultaneously administered methotrexate, hydrocortisone, and cytarabine) for 165 consecutive children with newly diagnosed ALL enrolled in Total Therapy Study XIIIA from December 1991 to August 1994. The 64 patients (39{\%}) who had 1 or more blast cells in cytocentrifuged preparations of cerebrospinal fluid at diagnosis, with or without associated higher-risk features, received additional doses of intrathecal chemotherapy during remission induction and the first year of continuation treatment. Patients with higher-risk leukemia, regardless of cerebrospinal fluid findings, also received additional doses of intrathecal chemotherapy during the first year of continuation treatment. Cranial irradiation was reserved for patients with higher-risk leukemia (22{\%} of the total). The 5-year cumulative risk of an isolated CNS relapse among all 165 patients was 1.2{\%} (95{\%} confidence interval, 0{\%} to 2.9{\%}), whereas that of any CNS relapse was 3.2{\%} (0.4{\%} to 6.0{\%}). The probability of surviving for 5 years without an adverse event of any type was 80.2{\%} ± 9.2{\%} (SE). Our results suggest that early intensification of intrathecal chemotherapy will reduce the risk of CNS relapse to a very low level in children with ALL, securing a higher event-free survival rate overall.",
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