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Treatment of relapsed precursor-B acute lymphoblastic leukemia with intensive chemotherapy: POG (Pediatric Oncology

Michael E Kelly1, Xiaomin Lu, Meenakshi Devidas

  • 1*Division of Pediatric Hematology/Oncology/Bone Marrow Transplant, Medical College of Wisconsin ‡Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, WI †Department of Biostatistics, University of Florida, Gainesville #Department of Pediatric Oncology & Hematology, Nemours Children's Clinic, Jacksonville, FL ∥Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA ¶Department of Pediatric Hematology-Oncology, University of Vermont, Burlington, VT **Department of Pediatric Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX §IWK Health Center, Halifax, NS, Canada.

Journal of Pediatric Hematology/Oncology
|July 27, 2013
PubMed

Insights

Intensifying treatment for relapsed pediatric acute lymphoblastic leukemia did not improve cure rates. New therapies are urgently needed to enhance survival for these young patients with leukemia.

Area of Science:

  • Pediatric Oncology
  • Hematology
  • Leukemia Research

Background:

  • Relapsed precursor-B acute lymphoblastic leukemia in children has a poor prognosis with cure rates below 50%.
  • Standard treatment intensification may not be sufficient to overcome refractory disease.

Purpose of the Study:

  • To evaluate if intensified chemotherapy regimens improve cure rates in pediatric patients with relapsed acute lymphoblastic leukemia.
  • To compare outcomes of chemotherapy alone versus chemotherapy followed by hematopoietic stem cell transplant.

Main Methods:

  • Patients received intensive asparaginase induction, followed by cycles of ifosfamide/etoposide and cytarabine/idarubicin.
  • Hematopoietic stem cell transplant was recommended for eligible patients with matched related donors.

Main Results:

  • No significant difference in disease-free survival between chemotherapy alone (45%) and chemotherapy with allogeneic stem cell transplant (50%).
  • Event-free survival (39.9%±6.2%) and overall survival (41.6%±6.1%) at 8 years showed no improvement compared to less intensive regimens.

Conclusions:

  • Intensified chemotherapy regimens do not significantly improve survival outcomes for pediatric relapsed acute lymphoblastic leukemia.
  • Novel therapeutic strategies are required to enhance cure rates in this high-risk pediatric population.

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