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Acute Leukemias

Long-term results of St Jude Total Therapy Studies 11, 12, 13A, 13B, and 14 for childhood acute lymphoblastic leukemia

Leukemia volume 24, pages 371–382 (2010)Cite this article

Abstract

We analyzed the long-term outcome of 1011 patients treated in five successive clinical trials (Total Therapy Studies 11, 12, 13A, 13B, and 14) between 1984 and 1999. The event-free survival improved significantly (P=0.003) from the first two trials conducted in the 1980s to the three more recent trials conducted in the 1990s. Approximately 75% of patients treated in the 1980s and 80% in the 1990s were cured. Early intensive triple intrathecal therapy, together with more effective systemic therapy, including consolidation and reinduction treatment (Studies 13A and 13B) as well as dexamethasone (Study 13B), resulted in a very low rate of isolated central nervous system (CNS) relapse rate (<2%), despite the reduced use of cranial irradiation. Factors consistently associated with treatment outcome were age, leukocyte count, immunophenotype, DNA index, and minimal residual disease level after remission induction treatment. Owing to concerns about therapy-related secondary myeloid leukemia and brain tumors, in our current trials we reserve the use of etoposide for patients with refractory or relapsed leukemia undergoing hematopoietic stem cell transplantation, and cranial irradiation for those with CNS relapse. The next main challenge is to further increase cure rates while improving quality of life for all patients.

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Acknowledgements

This work was supported by Grants (CA21765, CA51001, CA60419, CA78224, CA36401, and GM61393) from the National Cancer Institute, and by the American Lebanese Syrian Associated Charities (ALSAC).

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Authors and Affiliations

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

    C H Pui, J T Sandlund, R C Ribeiro, J E Rubnitz, D Campana, S Jeha, S C Howard, M L Metzger & D Bhojwani

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

    C H Pui, S C Raimondi, M Onciu, D Campana & J R Downing

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

    C H Pui, J T Sandlund, R C Ribeiro, J E Rubnitz, S C Raimondi, M Onciu, D Campana, L E Kun, S Jeha, S C Howard, M L Metzger, D Bhojwani, J R Downing, W E Evans & M V Relling

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

    D Pei & C Cheng

  5. Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, TN, USA

    L E Kun

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

    W E Evans & M V Relling

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  1. C H Pui
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Pui, C., Pei, D., Sandlund, J. et al. Long-term results of St Jude Total Therapy Studies 11, 12, 13A, 13B, and 14 for childhood acute lymphoblastic leukemia. Leukemia 24, 371–382 (2010). https://doi.org/10.1038/leu.2009.252

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