The treatment of standard-risk B-cell acute lymphoblastic leukemia with intensified postinduction therapy

This study evaluated if the intensified postinduction therapy is safe and effective to treat children with standard-risk (SR) B-cell acute lymphoblastic leukemia (B-ALL). The study concluded that the treatment excellently impacted survival among patients, but further intensifying the therapy might be unnecessary.

B-ALL is the most common childhood blood cancer. Induction therapy is the first treatment given for this disease. After this therapy, intensification is used to kill any cancer cells left in the body. Intensification improved the survival in children with a high risk (HR) a B-ALL’s return after disease-free periods. However, intensification has several toxic side effects. Whether patients with SR B-ALL truly need this treatment is unclear. Therefore, it is important to balance its benefits against the risks.

The study examined 5,377 children with SR B-ALL between 2005 and 2010. All of them received an induction therapy comprising 3 drugs – dexamethasone (Decadron), vincristine (Oncovin), and pegaspargase (Oncaspar). They were further divided into 3 groups – SR low, SR average, or SR high, based on the risk of ALL. 

Patients with SR-average disease received either regular intensification (group 1) for 4-weeks or augmented Berlin-Frankfurt-Munster (BFM) treatment for 8-weeks (group 2). Augmented BFM is a stronger version of intensification therapy. Those with SR-high disease also received augmented BFM. 

After 6 years of the treatment, 95.54% of the SR-average patients had survived. 87.8% of patients in group 1 and 89.1% of group 2 were in continuous complete remission after 6 years. 95.8% of patients in group 1 and 95.2% of those in group 2 were alive after 6 years. 

This study concluded that more than 95% of the children with SR B-ALL survived for 6 years after postinduction therapy. The authors suggested that further increase in the therapy’s intensity may not be needed.

This study did not compare the treatment with placebos (medicines with no effects). It also made changes in the treatment plan during the research. Additional studies are needed.