Comparative analysis of therapy results in children with acute lymphoblastic leukemia receiving ALL-MB-2002 and COALL-St.Petersburg-92 protocols
Abstract
In present article comparative efficacy analysis of two conceptually various acute lymphoblastic leukemia (ALL) chemotherapy programs from 18. 04. 2002 till 01. 01. 2007 aimed at definition of optimum ALL chemotherapy strategy in children is presented. To obtain an ultimate correct analysis patients data bases from Moscow and St.-Petersburg oncohematology departments have been united to the subsequent carrying out of meta-analysis. 292 primary patients are included in this analysis from ALL-MB-2002 group and 126 patients from COALL-St.Petersburg-92 group aged from 4 months to 18 years. Analysis of treatment results dynamics in ALL patients received COALL-St.Petersburg-92 protocol for 2 periods: from 01. 01. 1999 till 18. 04. 2002 and from 18. 04. 2002 till 01. 01. 2007 is also presented. Detailed comparison of two chemotherapy programs efficacy has not found any statistically significant differences concerning such factors, as complete remission rate, early death rate and relapse rate, and as number of children who are in continuous complete remission. Event-free survival (EFS) in both groups was 78 ± 3 and 78 ± 4 %, respectively (р = 0.85). The overall survival (OS) was 80 ± 5 % for patients treated according to ALL-MB-2002 protocol, and 83 ± 4 % for patients receiving COALL-St.Petersburg-92 protocol (р = 0.65). Though comparison of ALL-MB-2002 and COALL-St.Petersburg-92 protocols has shown, that efficacy of both chemotherapy regimens is identical, however such advantages of ALL-MB-2002 protocol as reduced toxicity and greater simplicity in implementation could be crucial for the choice of optimal chemotherapy strategy for childhood ALL in Russia.
About the Authors
E. G. BoychenkoRussian Federation
St.-Petersburg
J. V. Rumyantseva
Russian Federation
Moscow
N. I. Ponomareva
Russian Federation
Moscow
M. S. Livschiz
Russian Federation
St.-Petersburg
I. A. Garbusova
Russian Federation
St.-Petersburg
M. B. Belogurova
Russian Federation
St.-Petersburg
L. I. Schaz
Russian Federation
St.-Petersburg
D. V. Litvinov
Russian Federation
Moscow
S. N. Lagoiko
Russian Federation
Moscow
K. L. Kondratchik
Russian Federation
Moscow
N. R. Tukalova
Russian Federation
Moscow
A. I. Karachunsky
Russian Federation
Moscow
References
1. Riehm H., Gadner H., Henze G. et al. Results and significance of six randomized trials in four consecutive ALL-BFM studies. Hematol Blood Transfus 1990; 33: 439–50.
2. Schrappe M., Reiter A., Zimmermann M. et al. Long-term results of four consecutive trials in childhood ALL performed by the ALL-BFM study group from 1981 to 1995. Leukemia 2000; 14: 2205–22.
3. Reiter A., Schrappe M., Ludwig W. et al. Chemotherapy in 998 unselected childhood acute lymphoblastic leukemia patients. Results and conclusions of the multicenter trial ALL-BFM-86. Blood 1994; 84: 3122–33.
4. Janka-Schaub G. E., Winkler K., Gobel U. et al. Rapidly rotating combination chemotherapy in childhood acute lymphoblastic leukemia: preliminary results of a randomized comparison with conventional treatment. Leukemia 1988; 2: 73–8.
5. Harms D. O., Janka-Shaub G. E. Cooperative study group for childhood acute lymphoblastic leukemia (COALL): long-term follow-up of trials 82, 85, 89 and 92. Leukemia 2000; 14 (12): 2234–9.
6. Janka-Shaub G., Harms D., Goebel U. et al. Randomized comparison of rational chemotherapy in high-risk acute lymphoblastic leukaemia of childhood – follow up after 9 years. Eur J Pediatr 1996; 155: 640–8.
7. Rivera G., Raimondi S., Hancock M. et al. Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy. The Lancet 1991; 337 (8733): 61–6.
8. Tubergen D. G., Gilchrist G. S., O’Brien R. T. et al. Improved outcome with delayed intensification in children with acute lymphoblastic leukemia and intermediate presenting features: a Children’s Cancer Group phase III trial. J Clin Oncol 1993; 11: 527.
9. Veerman A. J. P., Hahlen K., Kamps W. A. et al. Dutch Childhood Leukemia Study Group: Early Results of Study ALL VI (1984–1988). Haematol Blood Transfus 1990; 33: 473–7.
10. Veerman A. J. P., Hahlen K., Kamps W. A. et al. High cure rate with a moderately intensive treatment regimen in non-high-risk childhood acute lymphoblastic leukemia: Results of protocol ALL-VI from the Dutch Leukemia Study Group. J Clin Oncol 1996; 14: 911–8.
11. Clavell L. A., Gelber R. D., Cohen H. J. et al. Four-agent induction and intensive asparaginase therapy for childhood acute lymphoblastic leukemia. N Engl J Med 1986; 315: 657–63.
12. Barr R. D., DeVeber L. L., Pai K. M., et al. Management of Children with Acute Lymphoblastic Leukemia by the Dana-Farber Cancer Institute Protocols. Am J Pediatr Hem Onc 1992; 14: 136–9.
13. Schorin M. A., Blattner S., Gelber R. et al. Treatment of childhood acute lymphoblastic leukemia: Results of Dana-Farber Institute/Children’s Hospital Acute Lymphoblastic Leukemia Consortium Protocol 85-01. J Clin Oncol 1994; 12: 740–7.
14. Karachunskiy A., Herold R., Von Stackelberg A. et al. Results of the first randomized multicentre trial on childhood acute lymphoblastic leukaemia in Russia. Leukemia 2008; 22 (6): 1144–53.
15. Карачунский А. И. Результаты мультицентрового исследования по лечению острого лимфобластного лейкоза у детей по программам ALL MB-91/ALL BFM-90: анализ эффективности и токсичности / А. И, Карачунский [и др.] // Тер. арх. – 2007. – 79 (7): 19–26.
16. Von Stackelberg A., Karatchunsky A., Miakova N. et al. Toxicity, supportive care and costs of two chemotherapy protocols for treatment of childhood ALL in Russia: BFM-90m and MB-91. Eur J Cancer 1999; 35: 1349–55.
17. Карачунский А. И. Стратегия терапии острого лимфобластного лейкоза у детей : Автореф. дис. … докт. мед. наук / А. И. Карачунский. – М., 1999.
18. Бойченко Э. Г. Сравнительный анализ режимов химиотерапии острого лимфобластного лейкоза BFM-90, MB-91 и PECO-92 в Москве и Санкт-Петербурге / Э. Г. Бойченко [и др.] // Онкогематология. – 2009. – 4: 12–22.
19. Лившиц М. С. Осложненные нейтропении на этапе консолидации протокола терапии детского острого лимфобластного лейкоза PECO-92 / М. С. Лившиц, Э. Г. Бойченко // Вестн. Рос. воен.-мед. акад. – 2005. – прил. 1 (13): 198–9.
20. Лившиц М. С. Влияние постцитостатической лейконейтропении на долговременные результаты лечения детского ОЛЛ (протокол PECO-92) : Тезисы юбилейной конференции СПбГПМА / М. С. Лившиц, Э. Г. Бойченко. – СПб., 2005. – 15–6.
21. Лившиц М. С. Влияние постцитостатических лейконейтропений и обусловленных ими инфекционных осложнений на результаты лечения детского острого лимфобластного лейкоза (протокол PECO-92) : Автореф. дис. … канд. мед. наук / М. С. Лившиц. – СПб., 2005.
Review
For citations:
Boychenko E.G., Rumyantseva J.V., Ponomareva N.I., Livschiz M.S., Garbusova I.A., Belogurova M.B., Schaz L.I., Litvinov D.V., Lagoiko S.N., Kondratchik K.L., Tukalova N.R., Karachunsky A.I. Comparative analysis of therapy results in children with acute lymphoblastic leukemia receiving ALL-MB-2002 and COALL-St.Petersburg-92 protocols. Oncohematology. 2010;(2):25-35. (In Russ.)