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dc.contributor.authorLawson, S E
dc.contributor.authorHarrison, G
dc.contributor.authorRichards, S
dc.contributor.authorOakhill, A
dc.contributor.authorStevens, R
dc.contributor.authorEden, Tim O B
dc.contributor.authorDarbyshire, P J
dc.date.accessioned2009-11-19T16:00:39Z
dc.date.available2009-11-19T16:00:39Z
dc.date.issued2000-03
dc.identifier.citationThe UK experience in treating relapsed childhood acute lymphoblastic leukaemia: a report on the medical research council UKALLR1 study. 2000, 108 (3):531-43 Br. J. Haematol.en
dc.identifier.issn0007-1048
dc.identifier.pmid10759711
dc.identifier.doi10.1046/j.1365-2141.2000.01891.x
dc.identifier.urihttp://hdl.handle.net/10541/86506
dc.description.abstractWe have examined the toxicity and overall outcome of the Medical Research Council UKALL R1 protocol for 256 patients with relapsed childhood acute lymphoblastic leukaemia (ALL). Second remission was achieved in over 95% of patients. Two patients died during induction and seven patients died of resistant disease. The overall actuarial event-free survival (EFS) at 5 years for all patients experiencing a first relapse was 46% (95% CI 40-52). Duration of first remission, site of relapse, age at diagnosis and sex emerged as factors of prognostic significance. Five-year EFS was only 7% for children relapsing in the bone marrow within 2 years of diagnosis, but was 77% for those relapsing without bone marrow involvement > 2.5 years from diagnosis. All analyses in this report are by treatment received. For those receiving chemotherapy alone, the 5-year EFS was 48%; for autologous bone marrow transplantation (BMT), the 5-year EFS was 47%; for unrelated donor BMT, it was 52%; and for related donor BMT, the 5-year EFS was 45%. The groups, however, were not comparable with respect to risk factor profile, and therefore direct comparison of EFS is misleading. Adjustment for time to transplant and prognostic factors was used to reduce the effects of biases between treatment groups, but did not suggest benefit for any particular treatment. There was failure of our planned randomization scheme in this trial with only 9% of those eligible being randomized, which highlights the difficulties in running randomized trials especially in patients who have relapsed from a previous trial. The optimal treatment for relapsed ALL therefore remains uncertain. Alternative approaches are clearly needed for those with early bone marrow relapse if outcome is to improve.
dc.language.isoenen
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols
dc.subject.meshAsparaginase
dc.subject.meshBone Marrow Transplantation
dc.subject.meshChild
dc.subject.meshChild, Preschool
dc.subject.meshCombined Modality Therapy
dc.subject.meshCyclophosphamide
dc.subject.meshCytarabine
dc.subject.meshDexamethasone
dc.subject.meshDisease-Free Survival
dc.subject.meshEpirubicin
dc.subject.meshGreat Britain
dc.subject.meshHumans
dc.subject.meshHydrocortisone
dc.subject.meshInfant
dc.subject.meshPrecursor Cell Lymphoblastic Leukemia-Lymphoma
dc.subject.meshPrognosis
dc.subject.meshRandomized Controlled Trials as Topic
dc.subject.meshRecurrence
dc.subject.meshStatistics, Nonparametric
dc.subject.meshThioguanine
dc.subject.meshTransplantation, Homologous
dc.subject.meshTreatment Outcome
dc.subject.meshVincristine
dc.titleThe UK experience in treating relapsed childhood acute lymphoblastic leukaemia: a report on the medical research council UKALLR1 study.en
dc.typeArticleen
dc.contributor.departmentDepartment of Haematology, Birmingham Children's Hospital, Birmingham, UK. isaac.lawson@btinternet.comen
dc.identifier.journalBritish Journal of Haematologyen
html.description.abstractWe have examined the toxicity and overall outcome of the Medical Research Council UKALL R1 protocol for 256 patients with relapsed childhood acute lymphoblastic leukaemia (ALL). Second remission was achieved in over 95% of patients. Two patients died during induction and seven patients died of resistant disease. The overall actuarial event-free survival (EFS) at 5 years for all patients experiencing a first relapse was 46% (95% CI 40-52). Duration of first remission, site of relapse, age at diagnosis and sex emerged as factors of prognostic significance. Five-year EFS was only 7% for children relapsing in the bone marrow within 2 years of diagnosis, but was 77% for those relapsing without bone marrow involvement > 2.5 years from diagnosis. All analyses in this report are by treatment received. For those receiving chemotherapy alone, the 5-year EFS was 48%; for autologous bone marrow transplantation (BMT), the 5-year EFS was 47%; for unrelated donor BMT, it was 52%; and for related donor BMT, the 5-year EFS was 45%. The groups, however, were not comparable with respect to risk factor profile, and therefore direct comparison of EFS is misleading. Adjustment for time to transplant and prognostic factors was used to reduce the effects of biases between treatment groups, but did not suggest benefit for any particular treatment. There was failure of our planned randomization scheme in this trial with only 9% of those eligible being randomized, which highlights the difficulties in running randomized trials especially in patients who have relapsed from a previous trial. The optimal treatment for relapsed ALL therefore remains uncertain. Alternative approaches are clearly needed for those with early bone marrow relapse if outcome is to improve.


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