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. J Pediatr Hematol Oncol 2007 Jun;29(6):369-75
Date
06/07/2007Pubmed ID
17551397DOI
10.1097/MPH.0b013e3180640d54Scopus ID
2-s2.0-34250018555 (requires institutional sign-in at Scopus site) 16 CitationsAbstract
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.
Author List
Salzer WL, Devidas M, Shuster JJ, Wang C, Chauvenet A, Asselin BL, Camitta BM, Kurtzberg J, Children's Oncology GroupMESH terms used to index this publication - Major topics in bold
AdolescentAdult
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
