Intensified PEG-L-asparaginase and antimetabolite-based therapy for treatment of higher risk precursor-B acute lymphoblastic leukemia: a report from the Children's Oncology Group. Journal of pediatric hematology/oncology : official journal of the American Society of Pediatric Hematology/Oncology [J Pediatr Hematol Oncol] Journal article | | Title | Intensified PEG-L-asparaginase and antimetabolite-based therapy for treatment of higher risk precursor-B acute lymphoblastic leukemia: a report from the Children's Oncology Group. | | Author(s) | Salzer WL, Devidas M, Shuster JJ, Wang C, Chauvenet A, Asselin BL, Camitta BM, Kurtzberg J, Children's Oncology Group | | Institution | Keesler Medical Center, Keesler AFB, Biloxi, MS, USA. Wanda.Salzer@amedd.army.mil | | Source | J Pediatr Hematol Oncol 2007 Jun; 29(6):369-75. | | MeSH | Adolescent
Adult
Antimetabolites, Antineoplastic
Antineoplastic Agents
Antineoplastic Combined Chemotherapy Protocols
Asparaginase
Child
Child, Preschool
Female
Humans
Infant
Male
Polyethylene Glycols
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Survival Analysis
Treatment Failure
Treatment Outcome
| | Abstract | The Pediatric Oncology Group 9203 pilot protocol was designed to determine the feasibility of delivering 29 biweekly doses of polyethylene glycol (PEG)-L-asparaginase, on a backbone of intensive multiagent antimetabolite-based consolidation and maintenance in higher risk B-precursor acute lymphoblastic leukemia. Between June 1992 and August 1993, 34 patients were enrolled on this limited institution pilot. The 5-year event-free survival (+/-standard error) and overall survival (+/-standard error) were 68+/-8% and 76+/-7%, respectively. Excessive toxicities attributed to PEG-L-asparaginase and myelosuppression associated with cytosine arabinoside were encountered during consolidation resulting in early study closure and modification of therapy for those already enrolled. Ninety-two percent of methotrexate/cytosine arabinoside cycles were associated with grades 3 to 4 myelosuppression, and 24% resulted in delays in therapy of more than 7 days. Fifteen PEG-L-asparaginase related toxicities occurred in 13 patients (8 allergy, 4 pancreas, 2 central nervous system, and 1 hemorrhage). Intensification of therapy with PEG-L-asparaginase resulted in event-free survival and overall survival comparable to other studies of the same time period without the use of agents associated with long-term complications, such as anthracyclines, epipodophyllotoxins, and alkylating agents. However, excessive toxicity occurred with intensified PEG-L-asparaginase and antimetabolite based therapy delivered on this schedule. | | Language | eng | | Pub Type(s) | Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
| | PubMed ID | 17551397 |
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