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Treatment of childhood acute lymphoblastic leukemia with delayed first intrathecal therapy and omission of prophylactic cranial irradiation: Results of the TPOG‐ALL‐2002 study
Author(s) -
Yeh TingChi,
Liang DerCherng,
Hou JenYin,
Jaing TangHer,
Lin DongTsamn,
Yang ChaoPing,
Peng ChingTien,
Hung IouJih,
Lin KaiHsin,
Hsiao ChihCheng,
Jou ShiannTarng,
Chiou ShyhShin,
Chen JiannShiuh,
Wang ShihChung,
Chang TeKau,
Wu KangHsi,
Sheen JiunnMing,
Yen HsiuJu,
Chen ShihHsiang,
Lu MengYao,
Li MengJu,
Chang TaiTsung,
Huang TingHuan,
Chang YuHsiang,
Chen ShuHuey,
Yang YungLi,
Chang HsiuHao,
Chen BowWen,
Lin PeiChin,
Cheng ChaoNeng,
Chao YuHua,
Yang ShangHsien,
Chao YuMei Y.,
Liu HsiChe
Publication year - 2018
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/cncr.31758
Subject(s) - medicine , regimen , adverse effect , lumbar puncture , intrathecal , prophylactic cranial irradiation , central nervous system , lymphoblastic leukemia , leukemia , pediatrics , surgery , cerebrospinal fluid , myocardial infarction , conventional pci
Background To eliminate cranial irradiation (CrRT)–related sequelae and to minimize the adverse impact of traumatic lumbar puncture (TLP) with blasts, the Taiwan Pediatric Oncology Group (TPOG) introduced a modified central nervous system (CNS)–directed regimen characterized by delayed triple intrathecal therapy (TIT) and the omission of CrRT for all children with newly diagnosed acute lymphoblastic leukemia (ALL). Methods This study compared the treatment outcomes of patients overall and patients with a non–CNS‐1 status (CNS‐2, CNS‐3, or TLP with blasts) in 2 treatment eras, one before and another after the revision of the TPOG‐ALL‐2002 protocol by the introduction of the modification (era 1 [2002‐2008] with CrRT and era 2 [2009‐2012] with delayed first TIT and no CrRT). Results There were no statistically significant differences in major outcomes between the 903 patients treated in era 1 and the 444 patients treated in era 2: the 5‐year event‐free survival (EFS) rates were 75.7% ± 1.4% and 72.1% ± 2.4%, respectively ( P = .260), and the cumulative risks of isolated CNS relapse were 4.0% ± 0.7% and 4.1% ± 1.0%, respectively ( P = .960). There were also no differences between non–CNS‐1 patients treated in era 1 (n = 76) and era 2 (n =28): the 5‐year EFS rates were 52.3% ± 5.8% and 62.9% ± 9.4%, respectively ( P = .199), and the cumulative risks of isolated CNS relapse were 6.3% ± 3.1% and 3.6% ± 3.5%, respectively ( P = .639). Notably, TLP with blasts was completely eliminated after the first TIT was delayed in era 2. Conclusions The delay of the first TIT until the clearance of circulating blasts and the total omission of CrRT did not compromise survival or CNS control in patients with childhood ALL, including those with a non–CNS‐1 status.