Recombinant interferon alfa given before and in combination with standard chemotherapy in children with acute lymphoblastic leukemia in first marrow relapse

A Pediatric Oncology Group Pilot Study

Judith Ochs, Martin L. Brecher, Donald Mahoney, Roger Vega, Brad H. Pollock, George R. Buchanan, V. Michael Whiteheod, Y. Rovindranath, Arnold I. Freeman

Research output: Contribution to journalArticle

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Abstract

Recombinant Interferon alfa (rIFN-α) was given to 31 children with acute lymphoblastic leukemia (ALL) in first on-therapy marrow relapse as the sole treatment (30 megaunits/m2/d intravenously × 10 days) before standard four-drug reinduction and during multiagent continuation therapy (30 megaunits/m2 subcutaneously × 3 consecutive days every 3 weeks). After 10 days of rIFN-α, there were two partial remissions (PRs); seven additional patients had either ≥ 25% reduction in the percentage of marrow blast cells or hypoplastic marrow. Two patients had progressive disease with an increase in leukocyte counts. All patients experienced influenza-like symptoms, and there were isolated instances of severe abdominal pain and personality change. Dose-limiting toxicity comprised grade III/IV transaminase elevation (two patients) and syncope with personality change (one patient). Twenty-three of 31 children (74%) subsequently achieved marrow remission using standard agents. One patient was taken off study during tenipo-side (VM-26) and cytarabine (ara-C) consolidation due to toxicity. Continuation therapy including rIFN-α pulse was well tolerated in the remaining children; only one patient required rIFN-α dosage reduction (for CNS toxicity). rIFN-α toxicity did not necessitate reductions in doses of standard chemotherapy agents or significant delays in therapy. Five patients remain in remission at 26 + to 36+ months; 13 patients relapsed in marrow, one in the meninges (7 months), and one in meninges, mediastinum, and lymph nodes (2 months). Two children were removed from study for marrow transplant. In summary, high-dose rIFN-α alone had a modest antileukemic effect. In contrast to the clinical experience with combined rIFN-α and chemotherapy in adults, rIFN-α given in a pulse-like manner through-out continuation therapy did not compromise the intensity of the standard chemotherapy regimen.

Original languageEnglish (US)
Pages (from-to)777-782
Number of pages6
JournalJournal of Clinical Oncology
Volume9
Issue number5
StatePublished - 1991

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Interferon-alpha
Bone Marrow
Pediatrics
Recurrence
Drug Therapy
Meninges
Cytarabine
Personality
Therapeutics
Teniposide
Syncope
Mediastinum
Transaminases
Leukocyte Count
Abdominal Pain
Human Influenza
Lymph Nodes
Transplants
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Recombinant interferon alfa given before and in combination with standard chemotherapy in children with acute lymphoblastic leukemia in first marrow relapse : A Pediatric Oncology Group Pilot Study. / Ochs, Judith; Brecher, Martin L.; Mahoney, Donald; Vega, Roger; Pollock, Brad H.; Buchanan, George R.; Whiteheod, V. Michael; Rovindranath, Y.; Freeman, Arnold I.

In: Journal of Clinical Oncology, Vol. 9, No. 5, 1991, p. 777-782.

Research output: Contribution to journalArticle

Ochs, Judith ; Brecher, Martin L. ; Mahoney, Donald ; Vega, Roger ; Pollock, Brad H. ; Buchanan, George R. ; Whiteheod, V. Michael ; Rovindranath, Y. ; Freeman, Arnold I. / Recombinant interferon alfa given before and in combination with standard chemotherapy in children with acute lymphoblastic leukemia in first marrow relapse : A Pediatric Oncology Group Pilot Study. In: Journal of Clinical Oncology. 1991 ; Vol. 9, No. 5. pp. 777-782.
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abstract = "Recombinant Interferon alfa (rIFN-α) was given to 31 children with acute lymphoblastic leukemia (ALL) in first on-therapy marrow relapse as the sole treatment (30 megaunits/m2/d intravenously × 10 days) before standard four-drug reinduction and during multiagent continuation therapy (30 megaunits/m2 subcutaneously × 3 consecutive days every 3 weeks). After 10 days of rIFN-α, there were two partial remissions (PRs); seven additional patients had either ≥ 25{\%} reduction in the percentage of marrow blast cells or hypoplastic marrow. Two patients had progressive disease with an increase in leukocyte counts. All patients experienced influenza-like symptoms, and there were isolated instances of severe abdominal pain and personality change. Dose-limiting toxicity comprised grade III/IV transaminase elevation (two patients) and syncope with personality change (one patient). Twenty-three of 31 children (74{\%}) subsequently achieved marrow remission using standard agents. One patient was taken off study during tenipo-side (VM-26) and cytarabine (ara-C) consolidation due to toxicity. Continuation therapy including rIFN-α pulse was well tolerated in the remaining children; only one patient required rIFN-α dosage reduction (for CNS toxicity). rIFN-α toxicity did not necessitate reductions in doses of standard chemotherapy agents or significant delays in therapy. Five patients remain in remission at 26 + to 36+ months; 13 patients relapsed in marrow, one in the meninges (7 months), and one in meninges, mediastinum, and lymph nodes (2 months). Two children were removed from study for marrow transplant. In summary, high-dose rIFN-α alone had a modest antileukemic effect. In contrast to the clinical experience with combined rIFN-α and chemotherapy in adults, rIFN-α given in a pulse-like manner through-out continuation therapy did not compromise the intensity of the standard chemotherapy regimen.",
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T1 - Recombinant interferon alfa given before and in combination with standard chemotherapy in children with acute lymphoblastic leukemia in first marrow relapse

T2 - A Pediatric Oncology Group Pilot Study

AU - Ochs, Judith

AU - Brecher, Martin L.

AU - Mahoney, Donald

AU - Vega, Roger

AU - Pollock, Brad H.

AU - Buchanan, George R.

AU - Whiteheod, V. Michael

AU - Rovindranath, Y.

AU - Freeman, Arnold I.

PY - 1991

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