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Outcome of Children with Standard-Risk T-Lineage Acute Lymphoblastic Leukemia--Comparison among Different Treatment
Yousif Matloub1, Linda Stork2, Barbara Asselin3
1Rainbow Babies & Children's Hospital, Division of Hematology-Oncology, Case Western Reserve University, Cleveland, Ohio.
Insights
Children with T-lineage acute lymphoblastic leukemia (T-ALL) achieved similar survival rates across different treatment protocols. Less intensive chemotherapy without cranial irradiation proved effective for standard-risk T-ALL.
Area of Science:
- Pediatric Oncology
- Hematology
- Leukemia Research
Background:
- T-lineage acute lymphoblastic leukemia (T-ALL) historically shows poorer outcomes than precursor-B acute lymphoblastic leukemia (B-ALL).
- Risk stratification for childhood leukemia previously based on age and white blood cell (WBC) count, irrespective of immunophenotype.
- Pediatric Oncology Group (POG) used more intensive protocols for T-ALL compared to Children's Cancer Group (CCG).
Purpose of the Study:
- Compare outcomes for standard-risk (SR) T-ALL patients treated on CCG and POG trials.
- Evaluate the effectiveness of different treatment intensities and cranial irradiation strategies.
- Identify optimal treatment approaches for SR T-ALL.
Main Methods:
- Retrospective analysis of SR T-ALL patients from 1996-2005 on CCG (1952, 1991) and POG (9404) trials.
- CCG regimens used a reduced-intensity Berlin-Frankfurt-Münster backbone with intensified treatment for slow responders.
- POG regimen involved more intensive therapy and routine cranial irradiation for all patients.
Main Results:
- No significant difference in 7-year event-free survival (EFS) between CCG and POG regimens (74.1-84.2%).
- Comparable 7-year overall survival rates across all three treatment groups (86.1-89.1%).
- CCG regimens achieved high EFS and survival with less intensive chemotherapy and no prophylactic cranial irradiation.
Conclusions:
- All evaluated regimens achieved comparable high rates of EFS and long-term survival for SR T-ALL.
- Less intensive chemotherapy backbone without prophylactic cranial irradiation is effective for SR T-ALL.
- Treatment strategies can be refined for SR T-ALL, potentially reducing treatment burden.
Background:
Children with T-lineage acute lymphoblastic leukemia ALL (T-ALL) historically have had inferior outcomes compared with the children with precursor-B ALL (B-ALL). After 1995, the Children's Cancer Group (CCG) treated patients with B- and T-ALL according to the National Cancer Institute (NCI) risk criteria, basing risk stratification on age and white blood cell (WBC) count regardless of immunophenotype. The Pediatric Oncology Group (POG) treated all the patients with T-ALL on separate, generally more intensive protocols than those used to treat the patients with B-ALL.
Procedure:
We compared the outcomes of children with T-ALL and NCI standard-risk (SR) criteria treated on CCG and POG trials between 1996 and 2005. CCG SR-ALL 1952 and 1991 enrolled 80 and 86 patients with T-ALL, respectively, utilizing a reduced intensity Berlin-Frankfurt-Münster backbone. Treatment was intensified for slow early responders and only patients with overt central nervous system leukemia received cranial irradiation. Eighty-four patients with T-ALL and SR features were enrolled on POG 9404 comprising more intensive therapy with all patients receiving cranial irradiation.
Results:
The 7-year event-free survival (EFS) for patients with SR T-ALL on CCG 1952, CCG 1991, and POG 9404 were 74.1 ± 5.8%, 81.8 ± 5.3%, and 84.2 ± 4.3%, respectively (P = 0.18). Overall 7-year survivals were 86.1 ± 4.6%, 88.3 ± 4.4%, 89.1 ± 3.6%, respectively (P = 0.84).
Conclusions:
Comparable high rates of EFS and long-term survival were achieved with all three regimens, with the CCG regimens utilizing a less intensive chemotherapy backbone without prophylactic cranial irradiation for patients with SR T-ALL.
