Dose Intensification of Methotrexate and Cytarabine During Intensified Continuation Chemotherapy for High-risk B-Precursor Acute Lymphoblastic Leukemia: POG 9406: A Report From the Children's Oncology Group

被引：7

作者：

Tower, Richard L. ^{[1
,2
]}

Jones, Tamekia L. ^{[3
,4
]}

Camitta, Bruce M. ^{[1
,2
]}

Asselin, Barbara L. ^{[8
]}

Bell, Beverly A. ^{[10
]}

Chauvenet, Allen ^{[11
]}

Devidas, Meenakshi ^{[7
]}

Halperin, Edward C. ^{[9
]}

Pullen, Jeanette ^{[12
]}

Shuster, Jonathan J. ^{[5
,6
]}

Winick, Naomi ^{[13
]}

Kurtzberg, Joanne ^{[14
]}

机构：

[1] Med Coll Wisconsin, MACC Fund Ctr Canc & Blood Disorders, Milwaukee, WI 53226 USA

[2] Childrens Hosp Wisconsin, Milwaukee, WI 53201 USA

[3] Univ Florida, Coll Med, Dept Biostat, Gainesville, FL USA

[4] Univ Florida, Coll Publ Hlth, Dept Biostat, Gainesville, FL USA

[5] Univ Florida, Dept Hlth Outcomes & Policy, Coll Med, Gainesville, FL USA

[6] Univ Florida, Coll Med, Clin & Translat Sci Inst, Gainesville, FL USA

[7] Dept Biostat, Childrens Oncol Grp, Gainesville, FL USA

[8] Univ Rochester, Dept Pediat, Golisano Childrens Hosp, Med Ctr, Rochester, NY 14627 USA

[9] New York Med Coll, Valhalla, NY 10595 USA

[10] Georgia Hlth Sci Univ, Dept Pediat, Augusta, GA USA

[11] W Virginia Univ, Dept Pediat, Charleston Div, Charleston, WV 25304 USA

[12] Univ Mississippi, Med Ctr, Dept Pediat Hematol Oncol, Jackson, MS 39216 USA

[13] Univ Texas SW Med Ctr Dallas, Dept Pediat, Dallas, TX 75390 USA

[14] Duke Univ, Med Ctr, Pediatr Blood & Marrow Transplant Program, Durham, NC USA

来源：

JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY | 2014年 / 36卷 / 05期

关键词：

methotrexate; cytarabine; acute lymphoblastic leukemia; pediatric; ACUTE LYMPHOCYTIC-LEUKEMIA; MINIMAL RESIDUAL DISEASE; THERAPY; CLASSIFICATION; IDENTIFICATION; SURVIVAL;

D O I：

10.1097/MPH.0000000000000131

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose: To determine the efficacy and toxicity of higher dose versus standard dose intravenous methotrexate (MTX) and pulses of high-dose cytosine arabinoside with asparaginase versus standard dose cytosine arabinoside and teniposide during intensified continuation therapy for higher risk pediatric B-precursor acute lymphoblastic leukemia (ALL). Patients and Methods: From 1994 to 1999, the Pediatric Oncology Group conducted a randomized phase III clinical trial in higher risk pediatric B-precursor ALL. A total of 784 patients were randomized in a 2 x 2 factorial design to receive MTX 1 g/m(2) versus 2.5 g/m(2) and to cytosine arabinoside/teniposide versus high-dose cytosine arabinoside/asparaginase during intensified continuation therapy. Results: Patients receiving standard dose MTX had a 5-year disease-free survival (DFS) of 71.8 +/- 2.4%; patients receiving higher dose MTX had a 5-year DFS of 71.7 +/- 2.4% (P = 0.55). Outcomes on cytosine arabinoside/teniposide (DFS of 70.4 +/- 2.4) were similar to higher dose cytosine arabinoside/asparaginase (DFS of 73.1 +/- 2.3%) (P = 0.41). Overall survival rates were not different between MTX doses or cytosine arabinoside/teniposide versus cytosine arabinoside/asparaginase. Conclusions: Increasing MTX dosing to 2.5 g/m(2) did not improve outcomes in higher risk pediatric B-precursor ALL. Giving high-dose cytarabine and asparaginase pulses instead of standard dose cytarabine and teniposide produced nonsignificant differences in outcomes, allowing for teniposide to be removed from ALL therapy.

引用

页码：353 / 361

页数：9

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