Improved outcome for children with acute lymphoblastic leukemia: Results of Total Therapy Study XIIIB at St Jude Children's Research Hospital

Ching Hon Pui, John T. Sandlund, Deqing Pei, Dario Campana, Gaston K. Rivera, Raul C. Ribeiro, Jeffrey E. Rubnitz, Bassem I. Razzouk, Scott C. Howard, Melissa M. Hudson, Cheng Cheng, Larry E. Kun, Susana C. Raimondi, Frederick G. Behm, James R. Downing, Mary V. Relling, William E. Evans

Research output: Contribution to journalArticle

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Abstract

St Jude Total Therapy Study XIIIB for childhood acute lymphoblastic leukemia (ALL) incorporated more stringent risk classification, early intensification of intrathecal chemotherapy, reinduction treatment, and the addition of dexamethasone to postremission therapy to increase the proportion of event-free survivors without jeopardizing their quality of life. Cranial irradiation was reserved for the 12% of patients who had T-cell ALL and a presenting leukocyte count of 100 × 109/L or more, or CNS-3 (5 or more leukocytes/μL with identifiable blast cells in an atraumatic sample or the presence of cranial nerve palsy) status. Among the 247 consecutive patients enrolled in the study, 117 were classified as having lower-risk leukemia and received mainly anti-metabolite-based continuation therapy; the 130 cases with higher-risk leukemia received more intensive continuation chemotherapy with multiple drug pairs administered in weekly rotation. The 5-year event-free survival estimate was 80.8% ± 2.6% (SE); the 8-year rate was 78.6% ± 5.8%. The 5-year cumulative risk of an isolated central nervous system (CNS) relapse was 1.7% ± 0.8%, and that of isolated plus combined CNS relapse was 3.0% ± 1.1%. The 5-year cumulative risks of etoposide-related myeloid malignancies were 1.8% ± 1.3% in the lower-risk patients who received a cumulative dose of 1.2 g/m2 and 5.0% ± 2.0% in the higher-risk patients who received a cumulative dose of up to 14.4 g/m2 (P = .18). Independent adverse prognostic features included the presence of MLL-AF4 or BCR-ABL fusion gene and minimal residual leukemia of 0.01% or more at the end of the 6-week remission induction phase. Our results suggest the efficacy of early intensification of intrathecal chemotherapy and provide the basis for studies omitting cranial irradiation altogether.

Original languageEnglish (US)
Pages (from-to)2690-2696
Number of pages7
JournalBlood
Volume104
Issue number9
DOIs
StatePublished - Nov 1 2004

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Chemotherapy
Research
Neurology
Cranial Irradiation
Leukemia
Central Nervous System
Drug Therapy
Therapeutics
Irradiation
Precursor T-Cell Lymphoblastic Leukemia-Lymphoma
Cranial Nerve Diseases
Remission Induction
Recurrence
T-cells
Gene Fusion
Etoposide
Metabolites
Leukocyte Count
Dexamethasone

ASJC Scopus subject areas

  • Hematology

Cite this

Pui, C. H., Sandlund, J. T., Pei, D., Campana, D., Rivera, G. K., Ribeiro, R. C., ... Evans, W. E. (2004). Improved outcome for children with acute lymphoblastic leukemia: Results of Total Therapy Study XIIIB at St Jude Children's Research Hospital. Blood, 104(9), 2690-2696. https://doi.org/10.1182/blood-2004-04-1616

Improved outcome for children with acute lymphoblastic leukemia : Results of Total Therapy Study XIIIB at St Jude Children's Research Hospital. / Pui, Ching Hon; Sandlund, John T.; Pei, Deqing; Campana, Dario; Rivera, Gaston K.; Ribeiro, Raul C.; Rubnitz, Jeffrey E.; Razzouk, Bassem I.; Howard, Scott C.; Hudson, Melissa M.; Cheng, Cheng; Kun, Larry E.; Raimondi, Susana C.; Behm, Frederick G.; Downing, James R.; Relling, Mary V.; Evans, William E.

In: Blood, Vol. 104, No. 9, 01.11.2004, p. 2690-2696.

Research output: Contribution to journalArticle

Pui, CH, Sandlund, JT, Pei, D, Campana, D, Rivera, GK, Ribeiro, RC, Rubnitz, JE, Razzouk, BI, Howard, SC, Hudson, MM, Cheng, C, Kun, LE, Raimondi, SC, Behm, FG, Downing, JR, Relling, MV & Evans, WE 2004, 'Improved outcome for children with acute lymphoblastic leukemia: Results of Total Therapy Study XIIIB at St Jude Children's Research Hospital', Blood, vol. 104, no. 9, pp. 2690-2696. https://doi.org/10.1182/blood-2004-04-1616
Pui, Ching Hon ; Sandlund, John T. ; Pei, Deqing ; Campana, Dario ; Rivera, Gaston K. ; Ribeiro, Raul C. ; Rubnitz, Jeffrey E. ; Razzouk, Bassem I. ; Howard, Scott C. ; Hudson, Melissa M. ; Cheng, Cheng ; Kun, Larry E. ; Raimondi, Susana C. ; Behm, Frederick G. ; Downing, James R. ; Relling, Mary V. ; Evans, William E. / Improved outcome for children with acute lymphoblastic leukemia : Results of Total Therapy Study XIIIB at St Jude Children's Research Hospital. In: Blood. 2004 ; Vol. 104, No. 9. pp. 2690-2696.
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abstract = "St Jude Total Therapy Study XIIIB for childhood acute lymphoblastic leukemia (ALL) incorporated more stringent risk classification, early intensification of intrathecal chemotherapy, reinduction treatment, and the addition of dexamethasone to postremission therapy to increase the proportion of event-free survivors without jeopardizing their quality of life. Cranial irradiation was reserved for the 12{\%} of patients who had T-cell ALL and a presenting leukocyte count of 100 × 109/L or more, or CNS-3 (5 or more leukocytes/μL with identifiable blast cells in an atraumatic sample or the presence of cranial nerve palsy) status. Among the 247 consecutive patients enrolled in the study, 117 were classified as having lower-risk leukemia and received mainly anti-metabolite-based continuation therapy; the 130 cases with higher-risk leukemia received more intensive continuation chemotherapy with multiple drug pairs administered in weekly rotation. The 5-year event-free survival estimate was 80.8{\%} ± 2.6{\%} (SE); the 8-year rate was 78.6{\%} ± 5.8{\%}. The 5-year cumulative risk of an isolated central nervous system (CNS) relapse was 1.7{\%} ± 0.8{\%}, and that of isolated plus combined CNS relapse was 3.0{\%} ± 1.1{\%}. The 5-year cumulative risks of etoposide-related myeloid malignancies were 1.8{\%} ± 1.3{\%} in the lower-risk patients who received a cumulative dose of 1.2 g/m2 and 5.0{\%} ± 2.0{\%} in the higher-risk patients who received a cumulative dose of up to 14.4 g/m2 (P = .18). Independent adverse prognostic features included the presence of MLL-AF4 or BCR-ABL fusion gene and minimal residual leukemia of 0.01{\%} or more at the end of the 6-week remission induction phase. Our results suggest the efficacy of early intensification of intrathecal chemotherapy and provide the basis for studies omitting cranial irradiation altogether.",
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AU - Campana, Dario

AU - Rivera, Gaston K.

AU - Ribeiro, Raul C.

AU - Rubnitz, Jeffrey E.

AU - Razzouk, Bassem I.

AU - Howard, Scott C.

AU - Hudson, Melissa M.

AU - Cheng, Cheng

AU - Kun, Larry E.

AU - Raimondi, Susana C.

AU - Behm, Frederick G.

AU - Downing, James R.

AU - Relling, Mary V.

AU - Evans, William E.

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N2 - St Jude Total Therapy Study XIIIB for childhood acute lymphoblastic leukemia (ALL) incorporated more stringent risk classification, early intensification of intrathecal chemotherapy, reinduction treatment, and the addition of dexamethasone to postremission therapy to increase the proportion of event-free survivors without jeopardizing their quality of life. Cranial irradiation was reserved for the 12% of patients who had T-cell ALL and a presenting leukocyte count of 100 × 109/L or more, or CNS-3 (5 or more leukocytes/μL with identifiable blast cells in an atraumatic sample or the presence of cranial nerve palsy) status. Among the 247 consecutive patients enrolled in the study, 117 were classified as having lower-risk leukemia and received mainly anti-metabolite-based continuation therapy; the 130 cases with higher-risk leukemia received more intensive continuation chemotherapy with multiple drug pairs administered in weekly rotation. The 5-year event-free survival estimate was 80.8% ± 2.6% (SE); the 8-year rate was 78.6% ± 5.8%. The 5-year cumulative risk of an isolated central nervous system (CNS) relapse was 1.7% ± 0.8%, and that of isolated plus combined CNS relapse was 3.0% ± 1.1%. The 5-year cumulative risks of etoposide-related myeloid malignancies were 1.8% ± 1.3% in the lower-risk patients who received a cumulative dose of 1.2 g/m2 and 5.0% ± 2.0% in the higher-risk patients who received a cumulative dose of up to 14.4 g/m2 (P = .18). Independent adverse prognostic features included the presence of MLL-AF4 or BCR-ABL fusion gene and minimal residual leukemia of 0.01% or more at the end of the 6-week remission induction phase. Our results suggest the efficacy of early intensification of intrathecal chemotherapy and provide the basis for studies omitting cranial irradiation altogether.

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