Abstract
The status of children with ALL treated on studies CCG-101/143 who developed CNS disease was investigated. Presymptomatic CNS therapy consisted of craniospinal radiation (XRT), cranial XRT plus IT MTX x6, or only IT MTX x6. Of the 791 pts who achieved remission, 63 (7.9%) developed CNS disease as the first evidence of relapse with no subsequent CNS episodes. The median time to isolated CNS relapse was 385 days, of these 63 pts 41 relapsed subsequently in the bone marrow (BM) and 38 died. Survivors had their initial relapse late (median: 457 days). Of the 63 pts with 1 isolated CNS relapse, 38 received presymptomatic CNS treatment with IT MTX alone; however, their disease-free (DF) survival was no different from the other 2 groups (p=0.1). Twenty-six pts (3.3%) developed 2 isolated CNS episodes and 20 of these pts subsequently relapsed in the BM. Only 3 pts survived, none of whom had any other relapses besides the 2 CNS relapses. Twenty-four pts (3%) had multiple CNS relapses (3 to 9 separate episodes); 20 died. The 4 survivors in this group have had no BM relapses, but have shown a pattern of chronic CNS disease. The DF survival at 84 mo for pts with 1 or more isolated CNS relapses was 16% and 8.4%, respectively. Time to the initial CNS relapse was found to be the most important factor for predicting outcome (p<0.0001). The data show that a CNS relapse is an indicator of poor prognosis. These pts require new therapeutic strategies to improve prevention and salvage.
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Ortega, J., Nesbit, M., Sather, H. et al. 927 LONG TERM RESULTS AFTER CNS RELAPSE IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA (ALL). Pediatr Res 19, 265 (1985). https://doi.org/10.1203/00006450-198504000-00957
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DOI: https://doi.org/10.1203/00006450-198504000-00957