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Evaluation of induction of remission, intensification, and central nervous system prophylactic treatment in acute lymphoblastic leukemia
Author(s) -
Muriel Federico Sackmann,
Pavlovsky Santiago,
Peñalver Jorge A.,
Hidalgo Guillermo,
Bonesana Angela Cebrian,
EppingerHelft Mariana,
de Macchi Graciela H.,
Pavlovsky Alfredo
Publication year - 1974
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(197408)34:2<418::aid-cncr2820340227>3.0.co;2-x
Subject(s) - medicine , prednisone , vincristine , daunorubicin , methotrexate , complete remission , toxicity , gastroenterology , group b , acute lymphocytic leukemia , surgery , asparaginase , lymphoblastic leukemia , chemotherapy , leukemia , cyclophosphamide
A total of 146 previously untreated acute lymphoblastic leukemia patients—126 children and 20 adults—has been studied prospectively in order to evaluate the relative efficacy and toxicity of: A) two induction of remission treatments (Group A: Daunorubicin‐vincristine‐prednisone vs. Group B: Adriamycin‐vincristine‐prednisone) and the use of the same drugs as reinforcement courses every 90 days during the 1st year of complete remission and every 180 days thereafter; B) the use of a short course of L‐asparaginase early in remission as intensification treatment (to half of Group A only (Group Aa); Groups Ab and B did not receive this treatment); and C) the use of 2400 rads cobalt‐60 irradiation to cranium coupled with five doses of intrathecal methotrexate as prophylactic CNS treatment. Complete remission was achieved in 85.7% of 112 cases of Group A and in 79.4% of 34 cases of Group B. The median duration of hematologic remission was 23, 21, and 22 months for Groups Aa, Ab, and B respectively. Toxicity was about the same for all regimens. The median duration of complete remission was 24 months, and of hematologic remission 27 months in the CNS prophylactically treated group, against 9 and 18 months, respectively, for the non‐treated group. We have concluded that: A) Adriamycin did not seem to be any better than Daunorubicin in inducing or prolonging complete remission when used in combination with vincristine and prednisone, either as induction treatment or in reinforcement courses; B) we did not demonstrate any significant difference in duration of remission, incidence, or site of relapse between L‐asparaginase‐treated and non‐treated patients; and C) the CNS prophylactic treatment employed in this trial is very effective in preventing CNS relapse, although it does not seem to prevent hematologic relapse.