Alternating drug pairs with or without periodic reinduction in children with acute lymphoblastic leukemia in second bone marrow remission - A pediatric oncology group study

BACKGROUND. Children with acute lymphoblastic leukemia (ALL) who experience hematologic recurrence while receiving chemotherapy or within 6 months aft er its cessation have a low cure rate. In this study (Pediatric Oncology Gr oup Protocol 8303) two methods were examined for improving the outcome in t hese children. METHODS. After remission induction with prednisone, vincristine, daunorubic in, and asparaginase (PVDA) and consolidation chemotherapy with teniposide and cytarabine, patients received weekly continuation chemotherapy with rot ating pairs of drugs, comprised of teniposide and cytarabine and vincristin e and cyclo-phosphamide. In addition, they were randomized to receive or no t receive repeated reinduction with PVDA. Patients with matched sibling don ors were allowed to receive allogeneic bone marrow transplantation (BMT) in stead of continued chemotherapy. RESULTS, Of 297 evaluable patients 258 (87%) achieved second complete hemat ologic remission. However, only 23 of these patients remained continuously free of leukemia greater than or equal to 7 years after chemotherapy or BMT . Neither PVDA pulses nor BMT appeared to influence outcome at a statistica lly significant level. CONCLUSIONS. The results of the current study confirm prior reports of the low cure rate of children with ALL who experience hematologic recurrence du ring initial therapy or shortly after its cessation. New approaches are nee ded to prevent and retreat hematologic recurrence in pediatric ALL patients . (C) 2000 American Cancer Society.