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Therapy and Follow up Studies

Effects of cranial radiation in children with high risk T cell acute lymphoblastic leukemia: a Pediatric Oncology Group report

Leukemia volume 14, pages 369–373 (2000)Cite this article

Abstract

contemporary chemotherapy has significantly improved event-free survival among patients with t cell-lineage acute lymphoblastic leukemia (t-all). unlike b-precursor all, most investigators are still using cranial radiation (crt) and are hesitant to rely solely on intrathecal therapy for t-all. in this study we assessed the effects of crt upon event-free survival and central nervous system (cns) relapses in a cohort of children with high risk features of t cell leukemia. in a series of six consecutive studies (1987–1995) patients were non-randomly assigned their cns prophylaxis per individual protocol. these protocols were based on pog 8704 which relied on rotating drug combinations (cytarabine/cyclophosphamide, teniposide/ ara-c, and vincristine/doxorubicin/6-mp/prednisone) post-induction. modifications such as high-dose cytarabine, intermediate-dose methotrexate, and the addition of g-csf, were designed to give higher cns drug levels (decreasing the need for crt), to eliminate epidophyllotoxin (decreasing the risk of secondary leukemia), and to reduce therapy-related neutropenia (pilot studies pog 9086, 9295, 9296, 9297, 9398). all patients included in this analysis qualified for pog high risk criteria, wbc >50 000/mm3 and/or CNS leukemia. Patients without CNS involvement received 16 doses of age-adjusted triple intra-thecal therapy (TIT = hydrocortisone, MTX, and cytarabine) whereas patients with CNS disease received three more doses of TIT during induction and consolidation. Patients who received CRT were treated with 2400 cGy (POG 8704) or 1800 cGy (POG 9086 and 9295). CNS therapy included CRT in 144 patients while the remaining 78 patients received no radiation by original protocol design. There were 155 males and 57 females with a median age of 8.2 years. The median WBC for the CRT+ and CRT− patients were 186 000/mm3 and 200 000/mm3, respectively. CNS involvement at diagnosis was seen in 16% of the CRT+ and 23% of the CRT− groups. The complete continuous remission rate (CCR) was not significantly different for the irradiated vs non-irradiated groups (P = 0.46). The 3-year event-free survival was 65% (s.e. 6%) and 63% (s.e. 4%) for the non-irradiated vs the radiated group. However, the 3-year CNS relapse rate was significantly higher amongst patients who did not receive CRT; 18% (s.e. 5%) vs 7% (s.e. 3%) in the irradiated group (P = 0.012). Our analysis in a non-randomized setting, suggests that CRT did not significantly correlate with event-free survival but omitting it had an adverse effect on the CNS involvement at the time of relapse.

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Acknowledgements

This work was supported in part by grants: CA-69177, CA-33603, CA-15525, CA-30969, CA-15989, CA-29139, and CA-39139 from the National Cancer Institute.

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Authors and Affiliations

  1. Divisions of Pediatric Hematology Oncology, Medical University of South Carolina, Charleston, SC, USA

    JH Laver & JC Barredo

  2. Stanford University, Stanford, CA, USA

    M Amylon & MP Link

  3. University of Massachusetts, Worcester, MA, USA

    M Schwenn

  4. Duke University, Durham, NC, USA

    J Kurtzberg

  5. Midwest Children's Cancer Center, Milwaukee, WI, USA

    BM Camitta

  6. University of Mississippi, Jackson, MS, USA

    J Pullen

  7. Johns Hopkins Hospital, Baltimore, MD, USA

    M Borowitz

  8. Children's Hospital of Michigan, Detroit, MI, USA

    Y Ravindranath

  9. Children's Memorial Hospital, Chicago, IL, USA

    SB Murphy

  10. Pediatric Oncology Group Statistical Office, University of Florida, Gainesville, FL, USA

    J Shuster

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Laver, J., Barredo, J., Amylon, M. et al. Effects of cranial radiation in children with high risk T cell acute lymphoblastic leukemia: a Pediatric Oncology Group report. Leukemia 14, 369–373 (2000). https://doi.org/10.1038/sj.leu.2401693

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