Treatment of childhood acute lymphoblastic leukemia with delayed first intrathecal therapy and omission of prophylactic cranial irradiation: Results of the TPOG-ALL-2002 study

Ting Chi Yeh, Der Cherng Liang, Jen Yin Hou, Tang Her Jaing, Dong Tsamn Lin, Chao Ping Yang, Ching Tien Peng, Iou Jih Hung, Kai Hsin Lin, Chih Cheng Hsiao, Shiann Tarng Jou, Shyh Shin Chiou, Jiann Shiuh Chen, Shih Chung Wang, Te Kau Chang, Kang Hsi Wu, Jiunn Ming Sheen, Hsiu Ju Yen, Shih Hsiang Chen, Meng Yao LuMeng Ju Li, Tai Tsung Chang, Ting Huan Huang, Yu Hsiang Chang, Shu Huey Chen, Yung Li Yang, Hsiu Hao Chang, Bow Wen Chen, Pei Chin Lin, Chao Neng Cheng, Yu Hua Chao, Shang Hsien Yang, Yu Mei Y. Chao, Hsi Che Liu

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

Background: To eliminate cranial irradiation (CrRT)–related sequelae and to minimize the adverse impact of traumatic lumbar puncture (TLP) with blasts, the Taiwan Pediatric Oncology Group (TPOG) introduced a modified central nervous system (CNS)–directed regimen characterized by delayed triple intrathecal therapy (TIT) and the omission of CrRT for all children with newly diagnosed acute lymphoblastic leukemia (ALL). Methods: This study compared the treatment outcomes of patients overall and patients with a non–CNS-1 status (CNS-2, CNS-3, or TLP with blasts) in 2 treatment eras, one before and another after the revision of the TPOG-ALL-2002 protocol by the introduction of the modification (era 1 [2002-2008] with CrRT and era 2 [2009-2012] with delayed first TIT and no CrRT). Results: There were no statistically significant differences in major outcomes between the 903 patients treated in era 1 and the 444 patients treated in era 2: the 5-year event-free survival (EFS) rates were 75.7% ± 1.4% and 72.1% ± 2.4%, respectively (P =.260), and the cumulative risks of isolated CNS relapse were 4.0% ± 0.7% and 4.1% ± 1.0%, respectively (P =.960). There were also no differences between non–CNS-1 patients treated in era 1 (n = 76) and era 2 (n =28): the 5-year EFS rates were 52.3% ± 5.8% and 62.9% ± 9.4%, respectively (P =.199), and the cumulative risks of isolated CNS relapse were 6.3% ± 3.1% and 3.6% ± 3.5%, respectively (P =.639). Notably, TLP with blasts was completely eliminated after the first TIT was delayed in era 2. Conclusions: The delay of the first TIT until the clearance of circulating blasts and the total omission of CrRT did not compromise survival or CNS control in patients with childhood ALL, including those with a non–CNS-1 status.

Original languageEnglish
JournalCancer
DOIs
Publication statusAccepted/In press - Jan 1 2018

Keywords

  • acute lymphoblastic leukemia
  • central nervous system
  • children
  • cranial irradiation
  • intrathecal chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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