Improved treatment results in boys with overt testicular relapse during or shortly after initial therapy for acute lymphoblastic leukemia

A Pediatric Oncology Group study

G. R. Buchanan, J. M. Boyett, B. H. Pollock, S. D. Smith, R. A. Yanofsky, T. Ghim, M. D. Wharam, W. M. Crist, T. J. Vietti, W. Johnson, G. K. Rivera

Research output: Contribution to journalArticle

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Abstract

Boys with acute lymphoblastic leukemia (ALL) who have overt testicular relapse (OTR) during initial continuation chemotherapy or within 6 months thereafter have poor outcomes, with long-term survival similar to patients with marrow relapse during treatment. In April 1983, the Pediatric Oncology Group (POG) adopted for these patients an intensive treatment protocol (POG 8303) consisting of a four-drug systemic reinduction (prednisone, vincristine, daunorubicin, and asparaginase), a brief intensive consolidation phase with teniposide and cytarabine, and a 2-year program of continuation chemotherapy with weekly rotating drug pairs (vincristine/cyclophosphamide and teniposide/cytarabine) with or without (by randomization) four-drug reinforcement pulses every 16 weeks. Bilateral testicular radiation (2600 cGy) was administered during reinduction, and intrathecal chemoprophylaxis was given every 4 to 6 weeks. Among 38 eligible study patients with OTR, 5 had prior or concomitant extramedullary relapse in other sites. The median duration of complete remission before OTR was 27 months (range, 10 to 42 months). All 38 patients achieved clinical remission after reinduction. Three patients withdrew while in remission, 22 had another relapse (12 marrow, 5 central nervous system (CNS), 2 testicular, 1 retroperitoneal, 1 prostate, and 1 eye), and 13 (34%) remain in complete remission from 32+ to 74+ months after OTR (median, 53+ months). Eighteen patients had their therapy electively discontinued, and five relapses occurred thereafter. These results are superior to those observed in patients with first marrow relapse treated with the same protocol. Approximately one third of patients with OTR treated with POG protocol 8303 exhibit prolonged second remissions with the potential for cure.

Original languageEnglish (US)
Pages (from-to)48-55
Number of pages8
JournalCancer
Volume68
Issue number1
StatePublished - 1991

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pediatrics
Recurrence
Teniposide
Therapeutics
Bone Marrow
Cytarabine
Vincristine
Pharmaceutical Preparations
Asparaginase
Drug Therapy
Daunorubicin
Chemoprevention
Clinical Protocols
Random Allocation
Prednisone
Cyclophosphamide
Prostate
Central Nervous System
Radiation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Improved treatment results in boys with overt testicular relapse during or shortly after initial therapy for acute lymphoblastic leukemia : A Pediatric Oncology Group study. / Buchanan, G. R.; Boyett, J. M.; Pollock, B. H.; Smith, S. D.; Yanofsky, R. A.; Ghim, T.; Wharam, M. D.; Crist, W. M.; Vietti, T. J.; Johnson, W.; Rivera, G. K.

In: Cancer, Vol. 68, No. 1, 1991, p. 48-55.

Research output: Contribution to journalArticle

Buchanan, GR, Boyett, JM, Pollock, BH, Smith, SD, Yanofsky, RA, Ghim, T, Wharam, MD, Crist, WM, Vietti, TJ, Johnson, W & Rivera, GK 1991, 'Improved treatment results in boys with overt testicular relapse during or shortly after initial therapy for acute lymphoblastic leukemia: A Pediatric Oncology Group study', Cancer, vol. 68, no. 1, pp. 48-55.
Buchanan, G. R. ; Boyett, J. M. ; Pollock, B. H. ; Smith, S. D. ; Yanofsky, R. A. ; Ghim, T. ; Wharam, M. D. ; Crist, W. M. ; Vietti, T. J. ; Johnson, W. ; Rivera, G. K. / Improved treatment results in boys with overt testicular relapse during or shortly after initial therapy for acute lymphoblastic leukemia : A Pediatric Oncology Group study. In: Cancer. 1991 ; Vol. 68, No. 1. pp. 48-55.
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abstract = "Boys with acute lymphoblastic leukemia (ALL) who have overt testicular relapse (OTR) during initial continuation chemotherapy or within 6 months thereafter have poor outcomes, with long-term survival similar to patients with marrow relapse during treatment. In April 1983, the Pediatric Oncology Group (POG) adopted for these patients an intensive treatment protocol (POG 8303) consisting of a four-drug systemic reinduction (prednisone, vincristine, daunorubicin, and asparaginase), a brief intensive consolidation phase with teniposide and cytarabine, and a 2-year program of continuation chemotherapy with weekly rotating drug pairs (vincristine/cyclophosphamide and teniposide/cytarabine) with or without (by randomization) four-drug reinforcement pulses every 16 weeks. Bilateral testicular radiation (2600 cGy) was administered during reinduction, and intrathecal chemoprophylaxis was given every 4 to 6 weeks. Among 38 eligible study patients with OTR, 5 had prior or concomitant extramedullary relapse in other sites. The median duration of complete remission before OTR was 27 months (range, 10 to 42 months). All 38 patients achieved clinical remission after reinduction. Three patients withdrew while in remission, 22 had another relapse (12 marrow, 5 central nervous system (CNS), 2 testicular, 1 retroperitoneal, 1 prostate, and 1 eye), and 13 (34{\%}) remain in complete remission from 32+ to 74+ months after OTR (median, 53+ months). Eighteen patients had their therapy electively discontinued, and five relapses occurred thereafter. These results are superior to those observed in patients with first marrow relapse treated with the same protocol. Approximately one third of patients with OTR treated with POG protocol 8303 exhibit prolonged second remissions with the potential for cure.",
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T2 - A Pediatric Oncology Group study

AU - Buchanan, G. R.

AU - Boyett, J. M.

AU - Pollock, B. H.

AU - Smith, S. D.

AU - Yanofsky, R. A.

AU - Ghim, T.

AU - Wharam, M. D.

AU - Crist, W. M.

AU - Vietti, T. J.

AU - Johnson, W.

AU - Rivera, G. K.

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N2 - Boys with acute lymphoblastic leukemia (ALL) who have overt testicular relapse (OTR) during initial continuation chemotherapy or within 6 months thereafter have poor outcomes, with long-term survival similar to patients with marrow relapse during treatment. In April 1983, the Pediatric Oncology Group (POG) adopted for these patients an intensive treatment protocol (POG 8303) consisting of a four-drug systemic reinduction (prednisone, vincristine, daunorubicin, and asparaginase), a brief intensive consolidation phase with teniposide and cytarabine, and a 2-year program of continuation chemotherapy with weekly rotating drug pairs (vincristine/cyclophosphamide and teniposide/cytarabine) with or without (by randomization) four-drug reinforcement pulses every 16 weeks. Bilateral testicular radiation (2600 cGy) was administered during reinduction, and intrathecal chemoprophylaxis was given every 4 to 6 weeks. Among 38 eligible study patients with OTR, 5 had prior or concomitant extramedullary relapse in other sites. The median duration of complete remission before OTR was 27 months (range, 10 to 42 months). All 38 patients achieved clinical remission after reinduction. Three patients withdrew while in remission, 22 had another relapse (12 marrow, 5 central nervous system (CNS), 2 testicular, 1 retroperitoneal, 1 prostate, and 1 eye), and 13 (34%) remain in complete remission from 32+ to 74+ months after OTR (median, 53+ months). Eighteen patients had their therapy electively discontinued, and five relapses occurred thereafter. These results are superior to those observed in patients with first marrow relapse treated with the same protocol. Approximately one third of patients with OTR treated with POG protocol 8303 exhibit prolonged second remissions with the potential for cure.

AB - Boys with acute lymphoblastic leukemia (ALL) who have overt testicular relapse (OTR) during initial continuation chemotherapy or within 6 months thereafter have poor outcomes, with long-term survival similar to patients with marrow relapse during treatment. In April 1983, the Pediatric Oncology Group (POG) adopted for these patients an intensive treatment protocol (POG 8303) consisting of a four-drug systemic reinduction (prednisone, vincristine, daunorubicin, and asparaginase), a brief intensive consolidation phase with teniposide and cytarabine, and a 2-year program of continuation chemotherapy with weekly rotating drug pairs (vincristine/cyclophosphamide and teniposide/cytarabine) with or without (by randomization) four-drug reinforcement pulses every 16 weeks. Bilateral testicular radiation (2600 cGy) was administered during reinduction, and intrathecal chemoprophylaxis was given every 4 to 6 weeks. Among 38 eligible study patients with OTR, 5 had prior or concomitant extramedullary relapse in other sites. The median duration of complete remission before OTR was 27 months (range, 10 to 42 months). All 38 patients achieved clinical remission after reinduction. Three patients withdrew while in remission, 22 had another relapse (12 marrow, 5 central nervous system (CNS), 2 testicular, 1 retroperitoneal, 1 prostate, and 1 eye), and 13 (34%) remain in complete remission from 32+ to 74+ months after OTR (median, 53+ months). Eighteen patients had their therapy electively discontinued, and five relapses occurred thereafter. These results are superior to those observed in patients with first marrow relapse treated with the same protocol. Approximately one third of patients with OTR treated with POG protocol 8303 exhibit prolonged second remissions with the potential for cure.

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