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Early response to induction is predictive of survival in childhood Philadelphia chromosome positive acute lymphoblastic leukaemia: results of the Medical Research Council ALL 97 trial

Early response to induction is predictive of survival in childhood Philadelphia chromosome positive acute lymphoblastic leukaemia: results of the Medical Research Council ALL 97 trial
Early response to induction is predictive of survival in childhood Philadelphia chromosome positive acute lymphoblastic leukaemia: results of the Medical Research Council ALL 97 trial
We report on the outcome of children with Philadelphia positive acute lymphoblastic leukaemia (Ph+ ALL) treated on the UK Medical Research Council (MRC) trial for childhood ALL, MRC ALL 97, between January 1997 and June 2002. Forty-two (2·3%) patients were Ph+. Nineteen (45%) had <25% blasts in bone marrow (BM) within the first 2 weeks of treatment and were defined as a good response group (GRG), the others as a poor response group (PRG). Thirty-six (86%) achieved first complete remission (CR1) at the end of induction, of which 28 underwent BM transplantation (BMT). The median follow-up was 42 months (range, 21–84). The 3-year event-free survival (EFS; 52%, 95% CI, 36–66%) was a considerable improvement on the previous MRC UKALL XI trial (27%). EFS for the GRG and PRG were 68% (43–84%) and 39% (18–59%), respectively (P = 0·03); presenting white cell count <50 × 10^9/l (P = 0·02) was predictive for overall survival. Changes in the MRC ALL97 trial within the study period resulted in some Ph+ ALL receiving daunorubicin and either prednisolone or dexamethasone during induction. Though the use of daunorubicin during induction was not a prospective study question, EFS was significantly better for those whose induction included this drug (P = 0·02). Steroid randomization was not stratified for Ph+ ALL patients and was not predictive for EFS. BMT in CR1 appeared to reduce the risk of a subsequent BM relapse. These results show significant improvement on previous MRC trials; future therapeutic strategies should include early intensive therapy and BMT in CR1.
0007-1048
35-44
Roy, Anindita
34629622-0169-4b06-a44e-eeeecbfdea79
Bradburn, Mike
c845a405-6815-49e3-a94d-b7489263d0f0
Moorman, Anthony V.
e4ced178-ee03-47ef-bc5e-25d8453951d5
Burrett, Julie
2b3de2dd-02a9-466f-99ca-79f11280b989
Love, Sharon
e9a3b667-e40f-4172-bab3-bfda14b1f28b
Kinsey, Sally E.
ae9c91c4-cb85-4da4-a8e6-d01409ad4656
Mitchell, Chris
2fd4b0ca-9253-4db6-98ae-ccd40a86ff4a
Vora, Ajay
9bf6b2a0-56fc-4797-86ea-d7108280cefc
Eden, Tim
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Lilleyman, John S.
fc25a6da-59ac-436b-a203-7cf383747912
Hann, Ian
acc48ebf-86d1-4ce5-a384-4f628d5d9031
Saha, Vaskar
504b1363-24e3-4a07-ad46-b154f27cb7b6
Roy, Anindita
34629622-0169-4b06-a44e-eeeecbfdea79
Bradburn, Mike
c845a405-6815-49e3-a94d-b7489263d0f0
Moorman, Anthony V.
e4ced178-ee03-47ef-bc5e-25d8453951d5
Burrett, Julie
2b3de2dd-02a9-466f-99ca-79f11280b989
Love, Sharon
e9a3b667-e40f-4172-bab3-bfda14b1f28b
Kinsey, Sally E.
ae9c91c4-cb85-4da4-a8e6-d01409ad4656
Mitchell, Chris
2fd4b0ca-9253-4db6-98ae-ccd40a86ff4a
Vora, Ajay
9bf6b2a0-56fc-4797-86ea-d7108280cefc
Eden, Tim
0cc6c71c-c6ea-401f-b8cb-b5610162f08d
Lilleyman, John S.
fc25a6da-59ac-436b-a203-7cf383747912
Hann, Ian
acc48ebf-86d1-4ce5-a384-4f628d5d9031
Saha, Vaskar
504b1363-24e3-4a07-ad46-b154f27cb7b6

Roy, Anindita, Bradburn, Mike, Moorman, Anthony V., Burrett, Julie, Love, Sharon, Kinsey, Sally E., Mitchell, Chris, Vora, Ajay, Eden, Tim, Lilleyman, John S., Hann, Ian and Saha, Vaskar (2005) Early response to induction is predictive of survival in childhood Philadelphia chromosome positive acute lymphoblastic leukaemia: results of the Medical Research Council ALL 97 trial. British Journal of Haematology, 129 (1), 35-44. (doi:10.1111/j.1365-2141.2005.05425.x).

Record type: Article

Abstract

We report on the outcome of children with Philadelphia positive acute lymphoblastic leukaemia (Ph+ ALL) treated on the UK Medical Research Council (MRC) trial for childhood ALL, MRC ALL 97, between January 1997 and June 2002. Forty-two (2·3%) patients were Ph+. Nineteen (45%) had <25% blasts in bone marrow (BM) within the first 2 weeks of treatment and were defined as a good response group (GRG), the others as a poor response group (PRG). Thirty-six (86%) achieved first complete remission (CR1) at the end of induction, of which 28 underwent BM transplantation (BMT). The median follow-up was 42 months (range, 21–84). The 3-year event-free survival (EFS; 52%, 95% CI, 36–66%) was a considerable improvement on the previous MRC UKALL XI trial (27%). EFS for the GRG and PRG were 68% (43–84%) and 39% (18–59%), respectively (P = 0·03); presenting white cell count <50 × 10^9/l (P = 0·02) was predictive for overall survival. Changes in the MRC ALL97 trial within the study period resulted in some Ph+ ALL receiving daunorubicin and either prednisolone or dexamethasone during induction. Though the use of daunorubicin during induction was not a prospective study question, EFS was significantly better for those whose induction included this drug (P = 0·02). Steroid randomization was not stratified for Ph+ ALL patients and was not predictive for EFS. BMT in CR1 appeared to reduce the risk of a subsequent BM relapse. These results show significant improvement on previous MRC trials; future therapeutic strategies should include early intensive therapy and BMT in CR1.

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Published date: 2005

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Local EPrints ID: 26582
URI: http://eprints.soton.ac.uk/id/eprint/26582
ISSN: 0007-1048
PURE UUID: 4076dfea-2e9b-4902-aec8-8594d51abfba

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Date deposited: 20 Apr 2006
Last modified: 15 Mar 2024 07:12

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Contributors

Author: Anindita Roy
Author: Mike Bradburn
Author: Anthony V. Moorman
Author: Julie Burrett
Author: Sharon Love
Author: Sally E. Kinsey
Author: Chris Mitchell
Author: Ajay Vora
Author: Tim Eden
Author: John S. Lilleyman
Author: Ian Hann
Author: Vaskar Saha

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