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Maintenance chemotherapy for childhood acute lymphoblastic leukaemia: better in the evening
Insights
Timing of chemotherapy administration significantly impacts relapse risk in childhood acute lymphoblastic leukemia. Evening chemotherapy schedules demonstrated a lower risk of relapse compared to morning schedules in children achieving remission.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Pharmacology
Background:
- Acute lymphoblastic leukemia (ALL) is the most common childhood cancer.
- Achieving remission and preventing relapse are critical for long-term survival in pediatric ALL.
- Maintenance chemotherapy protocols aim to eradicate residual disease and prevent recurrence.
Purpose of the Study:
- To investigate the impact of chemotherapy administration timing on disease-free survival in pediatric ALL patients.
- To determine if the time of day for administering maintenance chemotherapy influences relapse rates.
Main Methods:
- Retrospective review of 118 children with ALL in complete remission after induction therapy and meningeal prophylaxis.
- Maintenance chemotherapy included 6-mercaptopurine (6-MP) and methotrexate (MTX).
- Patients were stratified based on whether 6-MP and MTX were administered in the morning or evening.
Main Results:
- Disease-free survival was significantly better for children receiving chemotherapy in the evening.
- Cox proportional hazards regression analysis revealed a 4.6 times greater risk of relapse for morning versus evening schedules in patients disease-free for over 78 weeks.
Conclusions:
- The timing of maintenance chemotherapy administration is a crucial factor in relapse prevention for pediatric ALL.
- Evening administration of 6-mercaptopurine and methotrexate may improve long-term outcomes in children with ALL.
Abstract:
The course of 118 children with acute lymphoblastic leukaemia who had achieved complete remission with a standard induction protocol and had also received meningeal prophylaxis with intrathecal methotrexate (MTX) and cranial irradiation was reviewed. Maintenance chemotherapy consisted of daily 6-mercaptopurine (6-MP), weekly MTX, and monthly vincristine and prednisone. 82 children took 6-MP and MTX in the morning and 36 in the evening. Disease-free survival as determined by Kaplan-Meier analysis was better for children on evening chemotherapy. Regression analysis (Cox proportional hazards model, with evening vs morning schedule as exposure variable, and age at diagnosis, leucocytosis at diagnosis, and sex as covariates) showed that, for those surviving free of disease for longer than 78 weeks, the risk of relapsing was 4.6 times greater for the morning schedule than for the evening one.