CNS-3 status remains an independent adverse prognosis factor in children with acute lymphoblastic leukemia (ALL) treated without cranial irradiation: Results of EORTC Children Leukemia Group study 58951

被引:12
作者
Sirvent, N. [1 ,2 ]
Suciu, S. [3 ]
De Moerloose, B. [4 ]
Ferster, A. [5 ]
Mazingue, F. [6 ]
Plat, G. [7 ]
Yakouben, K. [8 ]
Uyttebroeck, A. [9 ]
Paillard, C. [10 ]
Costa, V [11 ]
Simon, P. [12 ]
Pluchart, C. [13 ]
Poiree, M. [14 ]
Minckes, O. [15 ]
Millot, F. [16 ]
Freycon, C. [17 ]
Maes, P. [18 ]
Hoyoux, C. [19 ]
Cave, H. [20 ,21 ]
Rohrlich, P. [14 ]
Bertrand, Y. [22 ]
Benoit, Y. [4 ]
机构
[1] CHU, Dept Pediat Hematol Oncol, Montpellier, France
[2] Univ Montpellier, Montpellier, France
[3] EORTC Headquarters, Brussels, Belgium
[4] Univ Ghent, Ghent Univ Hosp, Dept Pediat Hematol Oncol & Stem Cell Transplanta, Ghent, Belgium
[5] Univ Libre Bruxelles ULB, Childrens Univ Hosp Queen Fabiola, Dept Pediat Hematol Oncol, Brussels, Belgium
[6] CHRU, Dept Pediat Hematol Oncol, Lille, France
[7] CHU Hop Purpan, Dept Pediat Hematol Oncol, Toulouse, France
[8] Robert Debre Hosp, AP HP, Dept Pediat Hematol, Paris, France
[9] Univ Hosp Gasthuisberg, Dept Pediat Hematol Oncol, Leuven, Belgium
[10] Univ Hosp Hautepieire, Dept Pediat Hematol Oncol, Strasbourg, France
[11] Portuguese Oncol Inst, Dept Pediat, Porto, Portugal
[12] CHU Jean Minjoz Hosp, Pediat Hematol Unit, Besancon, France
[13] Amer Mem Hosp, Dept Pediat Hematol Oncol, Reims, France
[14] CHU Nice, Dept Pediat Hematol Oncol, Nice, France
[15] CHU, Dept Pediat Hematol Oncol, Caen, France
[16] Univ Hosp, Pediat Oncol Unit, Poitiers, France
[17] Univ Hosp, Dept Pediat Oncol, Grenoble, France
[18] Univ Hosp Antwerp, Dept Pediat, Antwerp, Belgium
[19] CHR Citadelle, Dept Pediat, Liege, Belgium
[20] Robert Debre Hosp, Assistance Publ Hop Paris AP HP, Dept Genet, Paris, France
[21] Univ Paris Diderot, Univ Inst Hematol, Paris Sorbonne Cite, INSERM,UMR 1131, Paris, France
[22] Univ Lyon 1, Inst Pediat Hematol & Oncol IHOP, Hosp Civils Lyon, Lyon, France
来源
ARCHIVES DE PEDIATRIE | 2021年 / 28卷 / 05期
关键词
Children; Acute lymphoblastic leukemia; Central nervous system; CANCER-INSTITUTE; CHILDHOOD; THERAPY; STANDARD; DEXAMETHASONE; ASPARAGINASE; DISEASE; RISK;
D O I
10.1016/j.arcped.2021.04.009
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Aim: To evaluate the prognostic significance of initial central nervous system (CNS) involvement of children with acute lymphoblastic leukemia (ALL) enrolled in the EORTC 58951 trial. Patients and methods: From 1998 to 2008, 1930 ALL patients were included in the randomized EORTC 58951 trial. Overall treatment intensity was adjusted according to known prognostic factors including the level of minimal residual disease after induction treatment. CNS-directed therapy comprised four to 11 courses of i.v. methotrexate (5 g/m(2)), and 10 to 19 intrathecal chemotherapy injections, depending on risk group and CNS status. Cranial irradiation was omitted for all patients. Results: The overall 8-year event-free survival (EFS) and overall survival (OS) rates were 81.3% and 88.1%, respectively. In the CNS-1, TPL+, CNS-2, and CNS-3 groups, the 8-year EFS rates were 82.1%, 77.1%, 78.3%, and 57.4%, respectively. Multivariable analysis indicated that initial CNS-3 status, but not CNS-2 or TLP+, was an independent adverse predictor of outcome. The 8-year incidence of isolated CNS relapse was 1.7% and of isolated or combined CNS relapse it was 3.7%. NCI high-risk group, male sex, CNS-2 and CNS-3 status were independent predictors for a higher incidence of any CNS relapse. Conclusions: CNS-3 status remains associated with poor prognosis and requires intensification of both systemic and CNS-directed therapy. (C) 2021 Published by Elsevier Masson SAS on behalf of French Society of Pediatrics.
引用
收藏
页码:411 / 416
页数:6
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