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Leukemia. 2014 Dec;28(12):2336-43. doi: 10.1038/leu.2014.142. Epub 2014 Apr 30.

A revised definition for cure of childhood acute lymphoblastic leukemia.

Author information

1
1] Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA [2] Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA.
2
Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA.
3
Centre for Translational Medicine, National University of Singapore, Singapore, Singapore.
4
Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
5
Department of Pediatrics, University of North Texas Health Science Center, Fort Worth, TX, USA.
6
Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA.
7
Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA.
8
Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA.

Abstract

With improved contemporary therapy, we reassess long-term outcome in patients completing treatment for childhood acute lymphoblastic leukemia (ALL) to determine when cure can be declared with a high degree of confidence. In six successive clinical trials between 1984 and 2007, 1291 (84.5%) patients completed all therapies in continuous complete remission. The post-therapy cumulative risk of relapse or development of a second neoplasm and the event-free survival rate and overall survival were analyzed according to the presenting features and the three treatment periods defined by relative outcome. Over the three treatment periods, there has been progressive increase in the rate of event-free survival (65.2% vs 74.8% vs 85.1% (P<0.001)) and overall survival (76.5% vs 81.1% vs 91.7% (P<0.001)) at 10 years. The most important predictor of outcome after completion of therapy was the type of treatment. In the most recent treatment period, which omitted the use of prophylactic cranial irradiation, the post-treatment cumulative risk of relapse was 6.4%, death in remission 1.5% and development of a second neoplasm 2.3% at 10 years, with all relapses except one occurring within 4 years of therapy. None of the 106 patients with the t(9;22)/BCR-ABL1, t(1;19)/TCF3-PBX1 or t(4;11)/MLL-AFF1 had relapsed after 2 years from completion of therapy. These findings demonstrate that with contemporary effective therapy that excludes cranial irradiation, approximately 6% of children with ALL may relapse after completion of treatment, and those who remain in remission at 4 years post treatment may be considered cured (that is, less than 1% chance of relapse).

PMID:
24781017
PMCID:
PMC4214904
DOI:
10.1038/leu.2014.142
[Indexed for MEDLINE]
Free PMC Article

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