A pilot study of intermediate-dose methotrexate and cytosine arabinoside, "spread-out" or "up-front," in continuation therapy for childhood non-T, non-B acute lymphoblastic leukemia: a Pediatric Oncology Group study
Article Abstract:
Chemotherapy is most often an empirical enterprise (based on observation), and the current protocols are a result of constant modification to improve effectiveness. Therefore, even the more successful protocols must be viewed as the new starting point from which further improvements may be made in treating cancers. Among children with acute lymphoblastic leukemia (ALL), five-year event-free survival rates of 70 percent may be achieved with the better chemotherapeutic protocols. Anxious to increase the success of the present protocols, researchers have investigated the addition of methotrexate and cytosine arabinoside to the standard chemotherapeutic regimen for ALL. This is based on evidence that methotrexate and cytosine arabinoside act synergistically with one another (they are more effective when combined than when either is administered alone). However, there is also evidence that the exact schedule of administering these two drugs is critical for success. Prior to devising a full-scale clinical trial, researchers conducted a pilot study involving 106 children with non-T, non-B acute lymphoblastic leukemia. All children received a conventional regimen of chemotherapy, the "backbone treatment", based on vincristine, prednisone, and L-asparaginase. As is customary, methotrexate and cytosine arabinoside were injected into the cerebrospinal fluid to prevent leukemia recurrence within the central nervous system. After four weeks, the patients who achieved complete responses were placed into one of two experimental groups. Forty-five high-risk patients were placed in the so-called "up-front" group, in which intermediate-dose methotrexate and cytosine arabinoside were given every three weeks for six cycles. Fifty-four patients deemed standard-risk were given the two drugs on a "spread-out" schedule of every 12 weeks for 6 cycles. The Kaplan-Meier estimates of four-year event-free survival were 71 percent for the standard-risk group and 53 percent for the high-risk group. These results support proceeding with a full-scale trial of these two drugs for continuation chemotherapy to improve the success of standard remission induction therapy in acute lymphoblastic leukemia. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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Improved treatment results in boys with overt testicular relapse during or shortly after initial therapy for acute lymphoblastic leukemia: a Pediatric Oncology Group study
Article Abstract:
The testis is one of the sites in the body in which acute lymphoblastic leukemia is more likely to recur. In the past, a recurrence of leukemic cells in the testis generally predicted a recurrence in the bone marrow and eventual death. With improved treatment, however, it is possible to successfully treat a significant proportion of the patients with acute lymphoblastic leukemia with overt testicular relapse. ("Overt" simply refers to the fact that the testis may be clearly seen to be enlarged; the leukemic cells are then confirmed microscopically.) In a series of 38 boys with testicular relapse, five had another relapse outside the bone marrow either previously or at the same time. The patients were treated with chemotherapy and radiation directly to the testicles. In addition, the boys were also given intrathecal chemotherapy. Intrathecal chemotherapy is administered directly into the cerebrospinal fluid and is designed to eliminate any leukemic cells which might be hiding in the central nervous system. All 38 patients achieved a second complete remission. Three patients withdrew from the study, and 22 patients again developed relapses. Of the 22 second relapses, 12 were in the bone marrow, two in the testes, one behind the peritoneal cavity (in the abdomen), one in the prostate, one in the eye, and five in the central nervous system. The remaining 13 patients enjoyed sustained remission lasting more than 53 months on average. The longest remission continues after 74 months, indicating that these 13 patients, or 34 percent of those treated, may potentially be cured of their disease. The results indicate that the combination of chemotherapy and testicular radiation may result in long-lasting remission in a third of patients with testicular relapse of acute lymphoblastic leukemia. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
User Contributions:
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