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

22 Scopus citations

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

Keywords

  • COG P9407
  • Infant ALL
  • Intensified therapy without SCT

ASJC Scopus subject areas

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

Fingerprint Dive into the research topics of 'Intensified chemotherapy without SCT in infant ALL: Results from COG P9407 (Cohort 3)'. Together they form a unique fingerprint.

  • Cite this

    Dreyer, Z. E., Hilden, J. M., Jones, T. L., Devidas, M., Winick, N. J., Willman, C. L., Harvey, R. C., Chen, I. M., Behm, F. G., Pullen, J., Wood, B. L., Carroll, A. J., Heerema, N. A., Felix, C. A., Robinson, B., Reaman, G. H., Salzer, W. L., Hunger, S. P., Carroll, W. 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