The treatment of primary childhood acute lymphocytic leukemia with intermediate dose methotrexate

Fifty-four consecutive children with acute lymphocytic leukemia (ALL) were treated from August 1974 until December of 1976 at Rosewell Park Memorial Institute (RPMI) according to a protocol which substituted cranial irradiation with systemic intermediate dose methotrexate (IDM) 500 mg/m2 each 3 weeks for a total of 3 courses immediately following induction. Of 54 patients, 52 went into remission (96%). There were 35 standard risk and 17 increased risk patients according to age and presenting white blood count (WBC). As of September 1979 9 of the 35 standard risk patients had relapsed: (five central nervous system (CNS), three systemic, and one testicular. The overall disease control is comparable to other published methods of therapy involving cranial irradiation but has the added advantage of not exposing these children to the long range side effects currently being observed in children who had previously been treated with prophylactic cranial irradiation.