Escalating intravenous methotrexate improves event-free survival in children with standard-risk acute lymphoblastic leukemia: a report from the Children's Oncology Group

被引：105

作者：

Matloub, Yousif ^{[1
]}

Bostrom, Bruce C. ^{[2
]}

Hunger, Stephen P. ^{[3
,4
]}

Stork, Linda C. ^{[5
]}

Angiolillo, Anne ^{[6
]}

Sather, Harland ^{[7
]}

La, Mei ^{[7
]}

Gastier-Foster, Julie M. ^{[8
]}

Heerema, Nyla A. ^{[9
]}

Sailer, Scott ^{[10
]}

Buckley, Patrick J. ^{[11
]}

Thomson, Blythe ^{[12
]}

Cole, Catherine ^{[13
]}

Nachman, James B. ^{[14
]}

Reaman, Gregory ^{[15
]}

Winick, Naomi ^{[16
]}

Carroll, William L. ^{[17
]}

Devidas, Meenakshi ^{[18
,19
,20
]}

Gaynon, Paul S. ^{[21
]}

机构：

[1] Case Western Reserve Univ, Rainbow Babies & Childrens Hosp, Div Hematol Oncol, Cleveland, OH 44106 USA

[2] Childrens Hosp & Clin Minnesota, Minneapolis, MN USA

[3] Univ Colorado, Sch Med, Aurora, CO USA

[4] Childrens Hosp, Aurora, CO USA

[5] Oregon Hlth & Sci Univ, Doernbecher Childrens Hosp, Portland, OR 97201 USA

[6] Childrens Natl Med Ctr, Washington, DC 20010 USA

[7] Operat Ctr, Childrens Oncol Grp, Arcadia, CA USA

[8] Nationwide Childrens Hosp, Lab Med, Columbus, OH USA

[9] Ohio State Univ, Dept Pathol, Columbus, OH 43210 USA

[10] Univ N Carolina, Chapel Hill, NC USA

[11] Duke Univ, Med Ctr, Durham, NC USA

[12] Univ Washington, Seattle Childrens Hosp, Seattle, WA 98195 USA

[13] Princess Margaret Hosp Children, Perth, WA, Australia

[14] Univ Chicago, Comer Childrens Hosp, Chicago, IL 60637 USA

[15] Childrens Oncol Grp, Chairs Off, Bethesda, MD USA

[16] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA

[17] NYU, Inst Canc, New York, NY USA

[18] Childrens Oncol Grp Stat, Gainesville, FL USA

[19] Ctr Data, Gainesville, FL USA

[20] Univ Florida, Gainesville, FL USA

[21] Childrens Hosp Los Angeles, Div Hematol Oncol, Los Angeles, CA 90027 USA

来源：

BLOOD | 2011年 / 118卷 / 02期

基金：

美国国家卫生研究院;

关键词：

TRAUMATIC LUMBAR PUNCTURE; NERVOUS-SYSTEM RELAPSE; LOW LEUKOCYTE COUNTS; CEREBROSPINAL-FLUID; CANCER-GROUP; INTERMEDIATE-RISK; DELAYED INTENSIFICATION; DOSE METHOTREXATE; CHILDHOOD; THERAPY;

D O I：

10.1182/blood-2010-12-322909

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Children's Cancer Group-1991 selected 2 components from the Children's Cancer Group studies shown to be effective in high-risk acute lymphoblastic leukemia and examined them in children with National Cancer Institute standard-risk acute B-precursor lymphoblastic leukemia. These were (1) vincristine and escalating IV methotrexate (MTX) without leucovorin rescue during the interim maintenance (IM) phases and (2) addition of a second delayed intensification (DI) phase. Eligible patients (n = 2078) were randomly assigned to regimens containing either oral (PO) MTX, PO mercaptopurine, dexamethasone, and vincristine or IV MTX during IM phases, and regimens with either single DI or double DI. Five-year event-free survival (EFS) and overall survival for patients on the PO MTX arms were 88.7% +/- 1.4% and 96% +/- 0.9% versus 92.6% +/- 1.2% and 96.5% +/- 0.8% for those on the IV MTX arms (P = .009, P = .66). Five-year EFS and overall survival for patients who received single DI were 90.9% +/- 1.3% and 97.1% +/- 0.8% versus 90.5% +/- 1.3% and 95.4% +/- 3.8% for those who received double DI (P = .71, P = .12). No advantage was found for a second DI; however, replacement of PO MTX, PO mercaptopurine, vincristine, and dexamethasone during IM with vincristine and escalating IV MTX improved EFS. (Blood.2011;118(2):243-251)

引用

页码：243 / 251

页数：9

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