In a nutshell
This study examined the long-term effectiveness of different treatment strategies for acute lymphoblastic leukemia (ALL) in young people. This study concluded that augmented treatment for rapid early responders was most beneficial, with improved survival at 10 years.
Some background
ALL is a cancer of the bone marrow. It leads to abnormal immune cells in the blood. Traditionally, a patient's initial response to medication decides what further treatment should be given. The three main stages of treatment for ALL are induction, consolidation (also called post induction intensification (PII)) and maintenance therapy. The type of response to induction treatment is determined by the number of ‘marrow blasts’ (immature white blood cells), measured 8 days after starting treatment. These are less than 25% in a rapid early responder (RER), and greater than 25% in a slow early responder (SER).
Idarubicin (Idamycin) and doxorubicin (Adriamycin) are chemotherapy drugs used to treat leukemia. They interfere with DNA and with the growth of cancer cells. Cyclophosphamide (Cytoxan) targets the immune system and stops the growth of cancer cells.
It is not known which treatment regimen has the best long-term outcomes in young people treated for ALL.
Methods & findings
2057 patients with high risk ALL were included in this study. Patients were aged 1-21 years old. 1299 RER patients received one of four PII treatment regimens. Each group varied in the length, or intensity of treatment. Of the 447 SER patients, half of these received doxorubicin and half received idarubicin and cyclophosphamide (i/c).
Event-free survival (EFS) is survival without experiencing complications related to cancer. At five years, the overall EFS for all patients was 71.8% and at 10 years it was 68.5%. The 10-year EFS rate for RER patients was 79.4%. EFS for SER was 70.2% at 5 years and 65.3% at 10 years.
In the RER group, at 10 years, the EFS for the standard treatment was 71%, and 79% for those who received the augmented (stronger) treatment. 81% of patients who received the standard strength and 87% of those who received the augmented treatment were alive at 10 years.
The bottom line
This study concluded that augmented PII treatment for RER was most beneficial, with improved EFS and survival at 10 years.
Published By :
Leukemia
Date :
Feb 28, 2019
