Long-term results of st jude total therapy studies 11, 12, 13a, 13b, and 14 for childhood acute lymphoblastic leukemia

C. H. Pui, D. Pei, J. T. Sandlund, R. C. Ribeiro, J. E. Rubnitz, S. C. Raimondi, M. Onciu, D. Campana, L. E. Kun, S. Jeha, C. Cheng, S. C. Howard, M. L. Metzger, D. Bhojwani, J. R. Downing, W. E. Evans, M. V. Relling

Research output: Contribution to journalArticle

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Abstract

We analyzed the long-term outcome of 1011 patients treated in five successive clinical trials (Total Therapy Studies 11, 12, 13A, 13B, and 14) between 1984 and 1999. The event-free survival improved significantly (P0.003) from the first two trials conducted in the 1980s to the three more recent trials conducted in the 1990s. Approximately 75% of patients treated in the 1980s and 80% in the 1990s were cured. Early intensive triple intrathecal therapy, together with more effective systemic therapy, including consolidation and reinduction treatment (Studies 13A and 13B) as well as dexamethasone (Study 13B), resulted in a very low rate of isolated central nervous system (CNS) relapse rate (2%), despite the reduced use of cranial irradiation. Factors consistently associated with treatment outcome were age, leukocyte count, immunophenotype, DNA index, and minimal residual disease level after remission induction treatment. Owing to concerns about therapy-related secondary myeloid leukemia and brain tumors, in our current trials we reserve the use of etoposide for patients with refractory or relapsed leukemia undergoing hematopoietic stem cell transplantation, and cranial irradiation for those with CNS relapse. The next main challenge is to further increase cure rates while improving quality of life for all patients.

Original languageEnglish (US)
Pages (from-to)371-382
Number of pages12
JournalLeukemia
Volume24
Issue number2
DOIs
StatePublished - Feb 1 2010

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Cranial Irradiation
Therapeutics
Central Nervous System
Remission Induction
Recurrence
Myeloid Leukemia
Hematopoietic Stem Cell Transplantation
Residual Neoplasm
Etoposide
Leukocyte Count
Brain Neoplasms
Dexamethasone
Disease-Free Survival
Leukemia
Quality of Life
Clinical Trials
DNA

Keywords

  • B-lineage ALL
  • Chemotherapy
  • CNS relapse
  • Leukemia
  • Prognostic factors
  • T-lineage ALL

ASJC Scopus subject areas

  • Hematology
  • Cancer Research
  • Anesthesiology and Pain Medicine

Cite this

Pui, C. H., Pei, D., Sandlund, J. T., Ribeiro, R. C., Rubnitz, J. E., Raimondi, S. C., ... Relling, M. V. (2010). Long-term results of st jude total therapy studies 11, 12, 13a, 13b, and 14 for childhood acute lymphoblastic leukemia. Leukemia, 24(2), 371-382. https://doi.org/10.1038/leu.2009.252

Long-term results of st jude total therapy studies 11, 12, 13a, 13b, and 14 for childhood acute lymphoblastic leukemia. / Pui, C. H.; Pei, D.; Sandlund, J. T.; Ribeiro, R. C.; Rubnitz, J. E.; Raimondi, S. C.; Onciu, M.; Campana, D.; Kun, L. E.; Jeha, S.; Cheng, C.; Howard, S. C.; Metzger, M. L.; Bhojwani, D.; Downing, J. R.; Evans, W. E.; Relling, M. V.

In: Leukemia, Vol. 24, No. 2, 01.02.2010, p. 371-382.

Research output: Contribution to journalArticle

Pui, CH, Pei, D, Sandlund, JT, Ribeiro, RC, Rubnitz, JE, Raimondi, SC, Onciu, M, Campana, D, Kun, LE, Jeha, S, Cheng, C, Howard, SC, Metzger, ML, Bhojwani, D, Downing, JR, Evans, WE & Relling, MV 2010, 'Long-term results of st jude total therapy studies 11, 12, 13a, 13b, and 14 for childhood acute lymphoblastic leukemia', Leukemia, vol. 24, no. 2, pp. 371-382. https://doi.org/10.1038/leu.2009.252
Pui, C. H. ; Pei, D. ; Sandlund, J. T. ; Ribeiro, R. C. ; Rubnitz, J. E. ; Raimondi, S. C. ; Onciu, M. ; Campana, D. ; Kun, L. E. ; Jeha, S. ; Cheng, C. ; Howard, S. C. ; Metzger, M. L. ; Bhojwani, D. ; Downing, J. R. ; Evans, W. E. ; Relling, M. V. / Long-term results of st jude total therapy studies 11, 12, 13a, 13b, and 14 for childhood acute lymphoblastic leukemia. In: Leukemia. 2010 ; Vol. 24, No. 2. pp. 371-382.
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