Intensified chemotherapy without SCT in infant ALL: Results from COG P9407 (Cohort 3)

Zoann E. Dreyer, Joanne M. Hilden, Tamekia L. Jones, Meenakshi Devidas, Naomi J. Winick, Cheryl L. Willman, Richard C. Harvey, I. Ming Chen, Fred G. Behm, Jeanette Pullen, Brent L. Wood, Andrew J. Carroll, Nyla A. Heerema, Carolyn A. Felix, Blaine Robinson, Gregory H. Reaman, Wanda L. Salzer, Stephen P. Hunger, William L. Carroll, Bruce M. Camitta

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Infants with acute lymphoblastic leukemia (ALL) present with aggressive disease and a poor prognosis. Early relapse within 6-9 months of diagnosis is common. Approximately 75% of infants have MLL-rearranged (MLL-R) ALL with event free survival (EFS) ranging from 20% to 30%. Children's Oncology Group (COG) P9407 used shortened (46 weeks), intensified therapy to address early relapse and poor EFS. Procedure: P9407 therapy was modified three times for induction toxicity resulting in three cohorts of therapy. One hundred forty-seven infants were enrolled in the third cohort. Results: We report an overall 5-year EFS and OS of 42.3±6% and 52.9±6.5% respectively. Poor prognostic factors included age ≤90 days at diagnosis, MLL-R ALL and white cell count ≥50,000/μl. For infants ≤90 days of age, the 5-year EFS was 15.5±10.1% and 48.5±6.7% for those >90 days (P<0.0001). Among infants >90 days of age, 5-year EFS rates were 43.8±8% for MLL-R versus 69.1±13.6% for MLL-germline ALL (P<0.0001). Conclusions: Age ≤90 days at diagnosis was the most important prognostic factor. Despite shortened therapy with early intensification, EFS remained less than 50% overall in MLL-R ALL.

Original languageEnglish (US)
Pages (from-to)419-426
Number of pages8
JournalPediatric Blood and Cancer
Volume62
Issue number3
DOIs
StatePublished - Mar 1 2015

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Disease-Free Survival
Drug Therapy
Recurrence
Therapeutics
Cell Count

Keywords

  • COG P9407
  • Infant ALL
  • Intensified therapy without SCT

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

Dreyer, Z. E., Hilden, J. M., Jones, T. L., Devidas, M., Winick, N. J., Willman, C. L., ... Camitta, B. M. (2015). Intensified chemotherapy without SCT in infant ALL: Results from COG P9407 (Cohort 3). Pediatric Blood and Cancer, 62(3), 419-426. https://doi.org/10.1002/pbc.25322

Intensified chemotherapy without SCT in infant ALL : Results from COG P9407 (Cohort 3). / Dreyer, Zoann E.; Hilden, Joanne M.; Jones, Tamekia L.; Devidas, Meenakshi; Winick, Naomi J.; Willman, Cheryl L.; Harvey, Richard C.; Chen, I. Ming; Behm, Fred G.; Pullen, Jeanette; Wood, Brent L.; Carroll, Andrew J.; Heerema, Nyla A.; Felix, Carolyn A.; Robinson, Blaine; Reaman, Gregory H.; Salzer, Wanda L.; Hunger, Stephen P.; Carroll, William L.; Camitta, Bruce M.

In: Pediatric Blood and Cancer, Vol. 62, No. 3, 01.03.2015, p. 419-426.

Research output: Contribution to journalArticle

Dreyer, ZE, Hilden, JM, Jones, TL, Devidas, M, Winick, NJ, Willman, CL, Harvey, RC, Chen, IM, Behm, FG, Pullen, J, Wood, BL, Carroll, AJ, Heerema, NA, Felix, CA, Robinson, B, Reaman, GH, Salzer, WL, Hunger, SP, Carroll, WL & Camitta, BM 2015, 'Intensified chemotherapy without SCT in infant ALL: Results from COG P9407 (Cohort 3)', Pediatric Blood and Cancer, vol. 62, no. 3, pp. 419-426. https://doi.org/10.1002/pbc.25322
Dreyer, Zoann E. ; Hilden, Joanne M. ; Jones, Tamekia L. ; Devidas, Meenakshi ; Winick, Naomi J. ; Willman, Cheryl L. ; Harvey, Richard C. ; Chen, I. Ming ; Behm, Fred G. ; Pullen, Jeanette ; Wood, Brent L. ; Carroll, Andrew J. ; Heerema, Nyla A. ; Felix, Carolyn A. ; Robinson, Blaine ; Reaman, Gregory H. ; Salzer, Wanda L. ; Hunger, Stephen P. ; Carroll, William L. ; Camitta, Bruce M. / Intensified chemotherapy without SCT in infant ALL : Results from COG P9407 (Cohort 3). In: Pediatric Blood and Cancer. 2015 ; Vol. 62, No. 3. pp. 419-426.
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abstract = "Background: Infants with acute lymphoblastic leukemia (ALL) present with aggressive disease and a poor prognosis. Early relapse within 6-9 months of diagnosis is common. Approximately 75{\%} of infants have MLL-rearranged (MLL-R) ALL with event free survival (EFS) ranging from 20{\%} to 30{\%}. Children's Oncology Group (COG) P9407 used shortened (46 weeks), intensified therapy to address early relapse and poor EFS. Procedure: P9407 therapy was modified three times for induction toxicity resulting in three cohorts of therapy. One hundred forty-seven infants were enrolled in the third cohort. Results: We report an overall 5-year EFS and OS of 42.3±6{\%} and 52.9±6.5{\%} respectively. Poor prognostic factors included age ≤90 days at diagnosis, MLL-R ALL and white cell count ≥50,000/μl. For infants ≤90 days of age, the 5-year EFS was 15.5±10.1{\%} and 48.5±6.7{\%} for those >90 days (P<0.0001). Among infants >90 days of age, 5-year EFS rates were 43.8±8{\%} for MLL-R versus 69.1±13.6{\%} for MLL-germline ALL (P<0.0001). Conclusions: Age ≤90 days at diagnosis was the most important prognostic factor. Despite shortened therapy with early intensification, EFS remained less than 50{\%} overall in MLL-R ALL.",
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T1 - Intensified chemotherapy without SCT in infant ALL

T2 - Results from COG P9407 (Cohort 3)

AU - Dreyer, Zoann E.

AU - Hilden, Joanne M.

AU - Jones, Tamekia L.

AU - Devidas, Meenakshi

AU - Winick, Naomi J.

AU - Willman, Cheryl L.

AU - Harvey, Richard C.

AU - Chen, I. Ming

AU - Behm, Fred G.

AU - Pullen, Jeanette

AU - Wood, Brent L.

AU - Carroll, Andrew J.

AU - Heerema, Nyla A.

AU - Felix, Carolyn A.

AU - Robinson, Blaine

AU - Reaman, Gregory H.

AU - Salzer, Wanda L.

AU - Hunger, Stephen P.

AU - Carroll, William L.

AU - Camitta, Bruce M.

PY - 2015/3/1

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N2 - Background: Infants with acute lymphoblastic leukemia (ALL) present with aggressive disease and a poor prognosis. Early relapse within 6-9 months of diagnosis is common. Approximately 75% of infants have MLL-rearranged (MLL-R) ALL with event free survival (EFS) ranging from 20% to 30%. Children's Oncology Group (COG) P9407 used shortened (46 weeks), intensified therapy to address early relapse and poor EFS. Procedure: P9407 therapy was modified three times for induction toxicity resulting in three cohorts of therapy. One hundred forty-seven infants were enrolled in the third cohort. Results: We report an overall 5-year EFS and OS of 42.3±6% and 52.9±6.5% respectively. Poor prognostic factors included age ≤90 days at diagnosis, MLL-R ALL and white cell count ≥50,000/μl. For infants ≤90 days of age, the 5-year EFS was 15.5±10.1% and 48.5±6.7% for those >90 days (P<0.0001). Among infants >90 days of age, 5-year EFS rates were 43.8±8% for MLL-R versus 69.1±13.6% for MLL-germline ALL (P<0.0001). Conclusions: Age ≤90 days at diagnosis was the most important prognostic factor. Despite shortened therapy with early intensification, EFS remained less than 50% overall in MLL-R ALL.

AB - Background: Infants with acute lymphoblastic leukemia (ALL) present with aggressive disease and a poor prognosis. Early relapse within 6-9 months of diagnosis is common. Approximately 75% of infants have MLL-rearranged (MLL-R) ALL with event free survival (EFS) ranging from 20% to 30%. Children's Oncology Group (COG) P9407 used shortened (46 weeks), intensified therapy to address early relapse and poor EFS. Procedure: P9407 therapy was modified three times for induction toxicity resulting in three cohorts of therapy. One hundred forty-seven infants were enrolled in the third cohort. Results: We report an overall 5-year EFS and OS of 42.3±6% and 52.9±6.5% respectively. Poor prognostic factors included age ≤90 days at diagnosis, MLL-R ALL and white cell count ≥50,000/μl. For infants ≤90 days of age, the 5-year EFS was 15.5±10.1% and 48.5±6.7% for those >90 days (P<0.0001). Among infants >90 days of age, 5-year EFS rates were 43.8±8% for MLL-R versus 69.1±13.6% for MLL-germline ALL (P<0.0001). Conclusions: Age ≤90 days at diagnosis was the most important prognostic factor. Despite shortened therapy with early intensification, EFS remained less than 50% overall in MLL-R ALL.

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