Treatment of childhood acute lymphoblastic leukemia with delayed first intrathecal therapy and omission of prophylactic cranial irradiation: Results of the TPOG-ALL-2002 study

Ting Chi Yeh, Der Cherng Liang, Jen Yin Hou, Tang Her Jaing, Dong Tsamn Lin, Chao Ping Yang, Ching Tien Peng, Iou Jih Hung, Kai Hsin Lin, Chih Cheng Hsiao, Shiann Tarng Jou, Shyh Shin Chiou, Jiann Shiuh Chen, Shih Chung Wang, Te Kau Chang, Kang Hsi Wu, Jiunn Ming Sheen, Hsiu Ju Yen, Shih Hsiang Chen, Meng Yao LuMeng Ju Li, Tai Tsung Chang, Ting Huan Huang, Yu Hsiang Chang, Shu Huey Chen, Yung Li Yang, Hsiu Hao Chang, Bow Wen Chen, Pei Chin Lin, Chao Neng Cheng, Yu Hua Chao, Shang Hsien Yang, Yu Mei Y. Chao, Hsi Che Liu

研究成果: Article

1 引文 (Scopus)

摘要

Background: To eliminate cranial irradiation (CrRT)–related sequelae and to minimize the adverse impact of traumatic lumbar puncture (TLP) with blasts, the Taiwan Pediatric Oncology Group (TPOG) introduced a modified central nervous system (CNS)–directed regimen characterized by delayed triple intrathecal therapy (TIT) and the omission of CrRT for all children with newly diagnosed acute lymphoblastic leukemia (ALL). Methods: This study compared the treatment outcomes of patients overall and patients with a non–CNS-1 status (CNS-2, CNS-3, or TLP with blasts) in 2 treatment eras, one before and another after the revision of the TPOG-ALL-2002 protocol by the introduction of the modification (era 1 [2002-2008] with CrRT and era 2 [2009-2012] with delayed first TIT and no CrRT). Results: There were no statistically significant differences in major outcomes between the 903 patients treated in era 1 and the 444 patients treated in era 2: the 5-year event-free survival (EFS) rates were 75.7% ± 1.4% and 72.1% ± 2.4%, respectively (P =.260), and the cumulative risks of isolated CNS relapse were 4.0% ± 0.7% and 4.1% ± 1.0%, respectively (P =.960). There were also no differences between non–CNS-1 patients treated in era 1 (n = 76) and era 2 (n =28): the 5-year EFS rates were 52.3% ± 5.8% and 62.9% ± 9.4%, respectively (P =.199), and the cumulative risks of isolated CNS relapse were 6.3% ± 3.1% and 3.6% ± 3.5%, respectively (P =.639). Notably, TLP with blasts was completely eliminated after the first TIT was delayed in era 2. Conclusions: The delay of the first TIT until the clearance of circulating blasts and the total omission of CrRT did not compromise survival or CNS control in patients with childhood ALL, including those with a non–CNS-1 status.

原文English
頁(從 - 到)4538-4547
頁數10
期刊Cancer
124
發行號23
DOIs
出版狀態Published - 2018 十二月 1

指紋

Cranial Irradiation
Taiwan
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Central Nervous System
Pediatrics
Spinal Puncture
Disease-Free Survival
Therapeutics
Survival Rate
Recurrence
Survival

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

引用此文

Yeh, Ting Chi ; Liang, Der Cherng ; Hou, Jen Yin ; Jaing, Tang Her ; Lin, Dong Tsamn ; Yang, Chao Ping ; Peng, Ching Tien ; Hung, Iou Jih ; Lin, Kai Hsin ; Hsiao, Chih Cheng ; Jou, Shiann Tarng ; Chiou, Shyh Shin ; Chen, Jiann Shiuh ; Wang, Shih Chung ; Chang, Te Kau ; Wu, Kang Hsi ; Sheen, Jiunn Ming ; Yen, Hsiu Ju ; Chen, Shih Hsiang ; Lu, Meng Yao ; Li, Meng Ju ; Chang, Tai Tsung ; Huang, Ting Huan ; Chang, Yu Hsiang ; Chen, Shu Huey ; Yang, Yung Li ; Chang, Hsiu Hao ; Chen, Bow Wen ; Lin, Pei Chin ; Cheng, Chao Neng ; Chao, Yu Hua ; Yang, Shang Hsien ; Chao, Yu Mei Y. ; Liu, Hsi Che. / Treatment of childhood acute lymphoblastic leukemia with delayed first intrathecal therapy and omission of prophylactic cranial irradiation : Results of the TPOG-ALL-2002 study. 於: Cancer. 2018 ; 卷 124, 編號 23. 頁 4538-4547.
@article{97c452d0a62748a691e6e89cb3490e5f,
title = "Treatment of childhood acute lymphoblastic leukemia with delayed first intrathecal therapy and omission of prophylactic cranial irradiation: Results of the TPOG-ALL-2002 study",
abstract = "Background: To eliminate cranial irradiation (CrRT)–related sequelae and to minimize the adverse impact of traumatic lumbar puncture (TLP) with blasts, the Taiwan Pediatric Oncology Group (TPOG) introduced a modified central nervous system (CNS)–directed regimen characterized by delayed triple intrathecal therapy (TIT) and the omission of CrRT for all children with newly diagnosed acute lymphoblastic leukemia (ALL). Methods: This study compared the treatment outcomes of patients overall and patients with a non–CNS-1 status (CNS-2, CNS-3, or TLP with blasts) in 2 treatment eras, one before and another after the revision of the TPOG-ALL-2002 protocol by the introduction of the modification (era 1 [2002-2008] with CrRT and era 2 [2009-2012] with delayed first TIT and no CrRT). Results: There were no statistically significant differences in major outcomes between the 903 patients treated in era 1 and the 444 patients treated in era 2: the 5-year event-free survival (EFS) rates were 75.7{\%} ± 1.4{\%} and 72.1{\%} ± 2.4{\%}, respectively (P =.260), and the cumulative risks of isolated CNS relapse were 4.0{\%} ± 0.7{\%} and 4.1{\%} ± 1.0{\%}, respectively (P =.960). There were also no differences between non–CNS-1 patients treated in era 1 (n = 76) and era 2 (n =28): the 5-year EFS rates were 52.3{\%} ± 5.8{\%} and 62.9{\%} ± 9.4{\%}, respectively (P =.199), and the cumulative risks of isolated CNS relapse were 6.3{\%} ± 3.1{\%} and 3.6{\%} ± 3.5{\%}, respectively (P =.639). Notably, TLP with blasts was completely eliminated after the first TIT was delayed in era 2. Conclusions: The delay of the first TIT until the clearance of circulating blasts and the total omission of CrRT did not compromise survival or CNS control in patients with childhood ALL, including those with a non–CNS-1 status.",
author = "Yeh, {Ting Chi} and Liang, {Der Cherng} and Hou, {Jen Yin} and Jaing, {Tang Her} and Lin, {Dong Tsamn} and Yang, {Chao Ping} and Peng, {Ching Tien} and Hung, {Iou Jih} and Lin, {Kai Hsin} and Hsiao, {Chih Cheng} and Jou, {Shiann Tarng} and Chiou, {Shyh Shin} and Chen, {Jiann Shiuh} and Wang, {Shih Chung} and Chang, {Te Kau} and Wu, {Kang Hsi} and Sheen, {Jiunn Ming} and Yen, {Hsiu Ju} and Chen, {Shih Hsiang} and Lu, {Meng Yao} and Li, {Meng Ju} and Chang, {Tai Tsung} and Huang, {Ting Huan} and Chang, {Yu Hsiang} and Chen, {Shu Huey} and Yang, {Yung Li} and Chang, {Hsiu Hao} and Chen, {Bow Wen} and Lin, {Pei Chin} and Cheng, {Chao Neng} and Chao, {Yu Hua} and Yang, {Shang Hsien} and Chao, {Yu Mei Y.} and Liu, {Hsi Che}",
year = "2018",
month = "12",
day = "1",
doi = "10.1002/cncr.31758",
language = "English",
volume = "124",
pages = "4538--4547",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "23",

}

Yeh, TC, Liang, DC, Hou, JY, Jaing, TH, Lin, DT, Yang, CP, Peng, CT, Hung, IJ, Lin, KH, Hsiao, CC, Jou, ST, Chiou, SS, Chen, JS, Wang, SC, Chang, TK, Wu, KH, Sheen, JM, Yen, HJ, Chen, SH, Lu, MY, Li, MJ, Chang, TT, Huang, TH, Chang, YH, Chen, SH, Yang, YL, Chang, HH, Chen, BW, Lin, PC, Cheng, CN, Chao, YH, Yang, SH, Chao, YMY & Liu, HC 2018, 'Treatment of childhood acute lymphoblastic leukemia with delayed first intrathecal therapy and omission of prophylactic cranial irradiation: Results of the TPOG-ALL-2002 study', Cancer, 卷 124, 編號 23, 頁 4538-4547. https://doi.org/10.1002/cncr.31758

Treatment of childhood acute lymphoblastic leukemia with delayed first intrathecal therapy and omission of prophylactic cranial irradiation : Results of the TPOG-ALL-2002 study. / Yeh, Ting Chi; Liang, Der Cherng; Hou, Jen Yin; Jaing, Tang Her; Lin, Dong Tsamn; Yang, Chao Ping; Peng, Ching Tien; Hung, Iou Jih; Lin, Kai Hsin; Hsiao, Chih Cheng; Jou, Shiann Tarng; Chiou, Shyh Shin; Chen, Jiann Shiuh; Wang, Shih Chung; Chang, Te Kau; Wu, Kang Hsi; Sheen, Jiunn Ming; Yen, Hsiu Ju; Chen, Shih Hsiang; Lu, Meng Yao; Li, Meng Ju; Chang, Tai Tsung; Huang, Ting Huan; Chang, Yu Hsiang; Chen, Shu Huey; Yang, Yung Li; Chang, Hsiu Hao; Chen, Bow Wen; Lin, Pei Chin; Cheng, Chao Neng; Chao, Yu Hua; Yang, Shang Hsien; Chao, Yu Mei Y.; Liu, Hsi Che.

於: Cancer, 卷 124, 編號 23, 01.12.2018, p. 4538-4547.

研究成果: Article

TY - JOUR

T1 - Treatment of childhood acute lymphoblastic leukemia with delayed first intrathecal therapy and omission of prophylactic cranial irradiation

T2 - Results of the TPOG-ALL-2002 study

AU - Yeh, Ting Chi

AU - Liang, Der Cherng

AU - Hou, Jen Yin

AU - Jaing, Tang Her

AU - Lin, Dong Tsamn

AU - Yang, Chao Ping

AU - Peng, Ching Tien

AU - Hung, Iou Jih

AU - Lin, Kai Hsin

AU - Hsiao, Chih Cheng

AU - Jou, Shiann Tarng

AU - Chiou, Shyh Shin

AU - Chen, Jiann Shiuh

AU - Wang, Shih Chung

AU - Chang, Te Kau

AU - Wu, Kang Hsi

AU - Sheen, Jiunn Ming

AU - Yen, Hsiu Ju

AU - Chen, Shih Hsiang

AU - Lu, Meng Yao

AU - Li, Meng Ju

AU - Chang, Tai Tsung

AU - Huang, Ting Huan

AU - Chang, Yu Hsiang

AU - Chen, Shu Huey

AU - Yang, Yung Li

AU - Chang, Hsiu Hao

AU - Chen, Bow Wen

AU - Lin, Pei Chin

AU - Cheng, Chao Neng

AU - Chao, Yu Hua

AU - Yang, Shang Hsien

AU - Chao, Yu Mei Y.

AU - Liu, Hsi Che

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: To eliminate cranial irradiation (CrRT)–related sequelae and to minimize the adverse impact of traumatic lumbar puncture (TLP) with blasts, the Taiwan Pediatric Oncology Group (TPOG) introduced a modified central nervous system (CNS)–directed regimen characterized by delayed triple intrathecal therapy (TIT) and the omission of CrRT for all children with newly diagnosed acute lymphoblastic leukemia (ALL). Methods: This study compared the treatment outcomes of patients overall and patients with a non–CNS-1 status (CNS-2, CNS-3, or TLP with blasts) in 2 treatment eras, one before and another after the revision of the TPOG-ALL-2002 protocol by the introduction of the modification (era 1 [2002-2008] with CrRT and era 2 [2009-2012] with delayed first TIT and no CrRT). Results: There were no statistically significant differences in major outcomes between the 903 patients treated in era 1 and the 444 patients treated in era 2: the 5-year event-free survival (EFS) rates were 75.7% ± 1.4% and 72.1% ± 2.4%, respectively (P =.260), and the cumulative risks of isolated CNS relapse were 4.0% ± 0.7% and 4.1% ± 1.0%, respectively (P =.960). There were also no differences between non–CNS-1 patients treated in era 1 (n = 76) and era 2 (n =28): the 5-year EFS rates were 52.3% ± 5.8% and 62.9% ± 9.4%, respectively (P =.199), and the cumulative risks of isolated CNS relapse were 6.3% ± 3.1% and 3.6% ± 3.5%, respectively (P =.639). Notably, TLP with blasts was completely eliminated after the first TIT was delayed in era 2. Conclusions: The delay of the first TIT until the clearance of circulating blasts and the total omission of CrRT did not compromise survival or CNS control in patients with childhood ALL, including those with a non–CNS-1 status.

AB - Background: To eliminate cranial irradiation (CrRT)–related sequelae and to minimize the adverse impact of traumatic lumbar puncture (TLP) with blasts, the Taiwan Pediatric Oncology Group (TPOG) introduced a modified central nervous system (CNS)–directed regimen characterized by delayed triple intrathecal therapy (TIT) and the omission of CrRT for all children with newly diagnosed acute lymphoblastic leukemia (ALL). Methods: This study compared the treatment outcomes of patients overall and patients with a non–CNS-1 status (CNS-2, CNS-3, or TLP with blasts) in 2 treatment eras, one before and another after the revision of the TPOG-ALL-2002 protocol by the introduction of the modification (era 1 [2002-2008] with CrRT and era 2 [2009-2012] with delayed first TIT and no CrRT). Results: There were no statistically significant differences in major outcomes between the 903 patients treated in era 1 and the 444 patients treated in era 2: the 5-year event-free survival (EFS) rates were 75.7% ± 1.4% and 72.1% ± 2.4%, respectively (P =.260), and the cumulative risks of isolated CNS relapse were 4.0% ± 0.7% and 4.1% ± 1.0%, respectively (P =.960). There were also no differences between non–CNS-1 patients treated in era 1 (n = 76) and era 2 (n =28): the 5-year EFS rates were 52.3% ± 5.8% and 62.9% ± 9.4%, respectively (P =.199), and the cumulative risks of isolated CNS relapse were 6.3% ± 3.1% and 3.6% ± 3.5%, respectively (P =.639). Notably, TLP with blasts was completely eliminated after the first TIT was delayed in era 2. Conclusions: The delay of the first TIT until the clearance of circulating blasts and the total omission of CrRT did not compromise survival or CNS control in patients with childhood ALL, including those with a non–CNS-1 status.

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SN - 0008-543X

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