Failure of early intensive chemotherapy to improve prognosis in childhood acute lymphocytic leukemia

The ability of intensive therapy, early in remission, to improve prognosis in childhood acute lymphocytic leukemia was tested in a randomized study. The intensive treatment included cyclophosphamide (200 mg/m² IV weekly × 4) and Adriamycin (40 mg/m² IV weeks 1 and 3). These drugs were not utilized during the induction or continuation phases of therapy. Treatment groups were similar with respect to patient age, sex, initial white cell count, and leukemic cell immunologic phenotype. Sixteen of 28 children who received the intensive phase of treatment relapsed, and one died in remission (pneumocystis pneumonia); 14/26 children who did not receive the intensive phase of treatment relapsed, and one died in remission (malignant histiocytosis). Times and sites of relapse were similar in both groups. Pneumocystis pneumonia (three cases) and herpes zoster (two cases) occurred only in children who received the intensive phase of treatment. In this study and in previously published reports, an early intensive phase of therapy did not improve prognosis in children with acute lymphocytic leukemia who also received three‐drug induction therapy, central nervous system prophylaxis, and continuation therapy with two or more agents.