TY - JOUR
T1 - Long-term results of Tokyo children's cancer study group trials for childhood acute lymphoblastic leukemia, 1984-1999
AU - Tsuchida, M.
AU - Ohara, A.
AU - Manabe, A.
AU - Kumagai, M.
AU - Shimada, H.
AU - Kikuchi, A.
AU - Mori, T.
AU - Saito, M.
AU - Akiyama, M.
AU - Fukushima, T.
AU - Koike, K.
AU - Shiobara, M.
AU - Ogawa, C.
AU - Kanazawa, T.
AU - Noguchi, Y.
AU - Oota, S.
AU - Okimoto, Y.
AU - Yabe, H.
AU - Kajiwara, M.
AU - Tomizawa, D.
AU - Ko, K.
AU - Sugita, K.
AU - Kaneko, T.
AU - Maeda, M.
AU - Inukai, T.
AU - Goto, H.
AU - Takahashi, H.
AU - Isoyama, K.
AU - Hayashi, Y.
AU - Hosoya, R.
AU - Hanada, R.
N1 - Funding Information:
We thank Dr Tomohiro Saito and Mrs Kaori Itagaki for statistical analysis and preparing and refining the data of the protocols of ALL in TCCSG. We also thank all the pediatricians and nurses participated in the treatment and follow-up of the patients for their works. Grant of Children’s Cancer Association, Japan, supported this study.
PY - 2010/2
Y1 - 2010/2
N2 - We report the long-term results of Tokyo Children's Cancer Study Group's studies L84-11, L89-12, L92-13, and L95-14 for 1846 children with acute lymphoblastic leukemia, which were conducted between 1984 and 1999. The value of event-free survival (EFS)s.±e. was 67.2±2.2% at 10 years in L84-11, which was not improved in the following two studies, and eventually improved to 75.0±1.8% at 10 years in L95-14 study. The lower EFS of the L89-12 reflected a high rate of induction failure because of infection and delayed remission in very high-risk patients. The L92-13 study was characterized by short maintenance therapy; it resulted in poor EFS, particularly in the standard-risk (SR) group and boys. Females did significantly better than males in EFS in the early three studies. The gender difference was not significant in overall survival, partly because >60% of the males survived after the testicular relapse. Randomized studies in the former three protocols revealed that intermediate-or high-dose methotrexate therapy significantly reduced the testicular relapse rate. In the L95-14 study, gender difference disappeared in EFS. Contrary to the results of larger-scale studies, the randomized control study in the L952-14 reconfirmed with updated data that dexamethasone 8 mg/m2 had no advantage over prednisolone 60 mg/m2 in the SR and intermediate-risk groups. Prophylactic cranial irradiation was assigned to 100, 80, 44, and 44% of the patients in the studies, respectively. Isolated central nervous system relapse rates decreased to <2% in the last two trials. Secondary brain tumors developed in 12 patients at 8-22 years after cranial irradiation. Improvement of the remission induction rates and the complete omission of irradiation are currently main objectives in our studies.
AB - We report the long-term results of Tokyo Children's Cancer Study Group's studies L84-11, L89-12, L92-13, and L95-14 for 1846 children with acute lymphoblastic leukemia, which were conducted between 1984 and 1999. The value of event-free survival (EFS)s.±e. was 67.2±2.2% at 10 years in L84-11, which was not improved in the following two studies, and eventually improved to 75.0±1.8% at 10 years in L95-14 study. The lower EFS of the L89-12 reflected a high rate of induction failure because of infection and delayed remission in very high-risk patients. The L92-13 study was characterized by short maintenance therapy; it resulted in poor EFS, particularly in the standard-risk (SR) group and boys. Females did significantly better than males in EFS in the early three studies. The gender difference was not significant in overall survival, partly because >60% of the males survived after the testicular relapse. Randomized studies in the former three protocols revealed that intermediate-or high-dose methotrexate therapy significantly reduced the testicular relapse rate. In the L95-14 study, gender difference disappeared in EFS. Contrary to the results of larger-scale studies, the randomized control study in the L952-14 reconfirmed with updated data that dexamethasone 8 mg/m2 had no advantage over prednisolone 60 mg/m2 in the SR and intermediate-risk groups. Prophylactic cranial irradiation was assigned to 100, 80, 44, and 44% of the patients in the studies, respectively. Isolated central nervous system relapse rates decreased to <2% in the last two trials. Secondary brain tumors developed in 12 patients at 8-22 years after cranial irradiation. Improvement of the remission induction rates and the complete omission of irradiation are currently main objectives in our studies.
KW - Acute lymphoblastic leukemia
KW - Children
KW - Cranial irradiation
KW - Long-term results
KW - Secondary malignancy
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U2 - 10.1038/leu.2009.260
DO - 10.1038/leu.2009.260
M3 - Article
C2 - 20033052
AN - SCOPUS:76749093120
SN - 0887-6924
VL - 24
SP - 383
EP - 396
JO - Leukemia
JF - Leukemia
IS - 2
ER -
