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Augmented therapy improves outcome for pediatric high risk acute lymphocytic leukemia: results of Children's Oncology Group trial P9906.


ABSTRACT: The augmented BFM regimen improves outcome for children with NCI high acute lymphoblastic leukemia (ALL). Patient age, sex, and presenting white blood cell count (WBC) can be used to identify a subset of approximately 12% of children with B-precursor ALL that had a 5-year continuous complete remission (CCR) rate of only about 50% on earlier Pediatric Oncology Group (POG) trials.Children's Oncology Group trial P9906 evaluated a modified augmented BFM regimen in 267 patients with particularly high risk B-precursor ALL. Minimal residual disease (MRD) was assessed in blood at day 8 and in marrow at day 29 of induction and correlated with outcome.The 5-year CCR probability for patients in P9906 was significantly better than that observed for similar patients on POG trials 8602/9006 (62.2 ± 3.7% vs. 50.6 ± 2.4%; P = 0.0007) but similar to POG 9406 (63.5 ± 2.4%; P = 0.81). Interim analysis showed poor central nervous system (CNS) control, especially in patients with initial WBC ? 100,000/microliter. Day 29 marrow MRD positive (? 0.01%) vs. negative patients had 5 year CCR rates of 37.1 ± 7.4% vs. 72.6 ± 4.3%; day 8 blood MRD positive vs. negative patients had 5 year CCR rates of 57.1 ± 4.6% vs.83.6 ± 6.3%. End induction marrow MRD predicted marrow but not CNS relapse. In multivariate analysis, day 29 MRD > 0.01%, initial WBC ? 100,000/µl, male gender, and day 8 blood MRD > 0.01% were significant prognostic factors.Augmented BFM therapy improved outcome for children with higher risk ALL. Day 8 blood and day 29 marrow MRD were strong prognostic factors in these patients.

SUBMITTER: Bowman WP 

PROVIDER: S-EPMC3136564 | biostudies-literature | 2011 Oct

REPOSITORIES: biostudies-literature

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Augmented therapy improves outcome for pediatric high risk acute lymphocytic leukemia: results of Children's Oncology Group trial P9906.

Bowman W Paul WP   Larsen Eric L EL   Devidas Meenakshi M   Linda Stephen B SB   Blach Laurie L   Carroll Andrew J AJ   Carroll William L WL   Pullen D Jeanette DJ   Shuster Jonathan J   Willman Cheryl L CL   Winick Naomi N   Camitta Bruce M BM   Hunger Stephen P SP   Borowitz Michael J MJ  

Pediatric blood & cancer 20110225 4


<h4>Background</h4>The augmented BFM regimen improves outcome for children with NCI high acute lymphoblastic leukemia (ALL). Patient age, sex, and presenting white blood cell count (WBC) can be used to identify a subset of approximately 12% of children with B-precursor ALL that had a 5-year continuous complete remission (CCR) rate of only about 50% on earlier Pediatric Oncology Group (POG) trials.<h4>Procedures</h4>Children's Oncology Group trial P9906 evaluated a modified augmented BFM regimen  ...[more]

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