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dc.contributor.authorRoy, Anindita
dc.contributor.authorBradburn, Mike
dc.contributor.authorMoorman, Anthony V
dc.contributor.authorBurrett, Julie
dc.contributor.authorLove, Sharon
dc.contributor.authorKinsey, Sally E
dc.contributor.authorMitchell, Christopher D
dc.contributor.authorVora, Ajay J
dc.contributor.authorEden, Tim O B
dc.contributor.authorLilleyman, John S
dc.contributor.authorHann, Ian M
dc.contributor.authorSaha, Vaskar
dc.date.accessioned2009-07-22T10:38:38Z
dc.date.available2009-07-22T10:38:38Z
dc.date.issued2005-04
dc.identifier.citationEarly response to induction is predictive of survival in childhood Philadelphia chromosome positive acute lymphoblastic leukaemia: results of the Medical Research Council ALL 97 trial. 2005, 129 (1):35-44 Br. J. Haematol.en
dc.identifier.issn0007-1048
dc.identifier.pmid15801953
dc.identifier.doi10.1111/j.1365-2141.2005.05425.x
dc.identifier.urihttp://hdl.handle.net/10541/74927
dc.description.abstractWe 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 x 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.
dc.language.isoenen
dc.subjectLeukaemiaen
dc.subject.meshAdolescent
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols
dc.subject.meshBone Marrow Transplantation
dc.subject.meshChild
dc.subject.meshChild, Preschool
dc.subject.meshCombined Modality Therapy
dc.subject.meshDaunorubicin
dc.subject.meshDexamethasone
dc.subject.meshFemale
dc.subject.meshHumans
dc.subject.meshInfant
dc.subject.meshLeukocyte Count
dc.subject.meshMale
dc.subject.meshPhiladelphia Chromosome
dc.subject.meshPrecursor Cell Lymphoblastic Leukemia-Lymphoma
dc.subject.meshPrednisolone
dc.subject.meshPrognosis
dc.subject.meshSurvival Analysis
dc.subject.meshTreatment Outcome
dc.titleEarly response to induction is predictive of survival in childhood Philadelphia chromosome positive acute lymphoblastic leukaemia: results of the Medical Research Council ALL 97 trial.en
dc.typeArticleen
dc.contributor.departmentCancer Research UK Children's Cancer Group, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.en
dc.identifier.journalBritish Journal of Haematologyen
html.description.abstractWe 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 x 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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