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Therapy

Low-dose oral etoposide-based induction regimen for children with acute lymphoblastic leukemia in first bone marrow relapse

Leukemia volume 18, pages 1581–1586 (2004)Cite this article

Abstract

We evaluated the clinical response to low-dose etoposide in relapsed acute lymphoblastic leukemia (ALL). Of the 45 patients with ALL in first bone marrow relapse enrolled on the ALL R15 protocol, 44 had received epipodophyllotoxins during frontline therapy. In the first week of remission induction therapy, patients received etoposide (50 mg/m2 per day) administered orally as a single agent once or twice daily. On Day 8, patients started to receive dexamethasone, vincristine, and L-asparaginase. Etoposide was administered until Day 22. Two courses of consolidation therapy were followed by continuation therapy or hematopoietic stem cell transplantation. After 7 days of single-agent etoposide treatment, peripheral blast cell counts (P=0.013) and percentages of bone marrow blasts (P=0.016) were significantly reduced. In all, 38 (84.4%) attained second remission. Only time to relapse was significantly associated with outcome (P=0.025): the 5-year event-free survival estimates (±se) were 52.0±9.6% for those with late relapse and 20.0±8.0% for those with early relapse. We conclude that low-dose etoposide administered orally has a cytoreductive effect in relapsed ALL.

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Acknowledgements

We thank Julia Cay Jones, PhD, for editing the paper; Melissa Hudson, MD, for helpful discussion; Emily Kyzer, PNP, and Jeana Cromer for editorial assistance; Imella Herrington for secretarial assistance; and Yinmei Zhou, Annette Stone, Stacye Richardson, Liza Emanus, Helen Powers and Barbara Cruchon for their assistance in data collection.

This work was supported in part by a Cancer Center Support Grant (CA21765) from the National Cancer Institute and by the American Lebanese Syrian Associated Charities. Ching-Hon Pui is the American Cancer Society – FM Kirby Clinical Research Professor.

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Authors and Affiliations

  1. Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN, USA

    N Hijiya, A Gajjar, J T Sandlund, R C Ribeiro, J E Rubnitz, S Jeha, G K Rivera & C-H Pui

  2. Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA

    Z Zhang, W Liu & C Cheng

  3. Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA

    S C Raimondi, F G Behm & C-H Pui

  4. Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA

    M V Relling

  5. Department of Pharmacy and the Center for Pediatric Pharmacokinetics and Therapeutics, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA

    M V Relling

  6. College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    N Hijiya, A Gajjar, J T Sandlund, R C Ribeiro, J E Rubnitz, S Jeha, C Cheng, S C Raimondi, F G Behm, G K Rivera & C-H Pui

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  1. N Hijiya
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Correspondence to N Hijiya.

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Hijiya, N., Gajjar, A., Zhang, Z. et al. Low-dose oral etoposide-based induction regimen for children with acute lymphoblastic leukemia in first bone marrow relapse. Leukemia 18, 1581–1586 (2004). https://doi.org/10.1038/sj.leu.2403467

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  • DOI: https://doi.org/10.1038/sj.leu.2403467

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