https://scholars.lib.ntu.edu.tw/handle/123456789/525206
標題: | Treatment of childhood acute lymphoblastic leukemia with delayed first intrathecal therapy and omission of prophylactic cranial irradiation: Results of the TPOG-ALL-2002 study | 作者: | Yeh T.-C. Liang D.-C. Hou J.-Y. Jaing T.-H. Lin D.-T. Yang C.-P. Peng C.-T. Hung I.-J. Lin K.-H. Hsiao C.-C. SHIANN-TANG JOU Chiou S.-S. Chen J.-S. Wang S.-C. Chang T.-K. Wu K.-H. Sheen J.-M. Yen H.-J. Chen S.-H. MENG-YAO LU MENG-JU LI Chang T.-T. Huang T.-H. Chang Y.-H. Chen S.-H. YUNG-LI YANG HSIU-HAO CHANG Chen B.-W. Lin P.-C. Cheng C.-N. Chao Y.-H. Yang S.-H. Chao Y.-M.Y. Liu H.-C. |
公開日期: | 2018 | 出版社: | John Wiley and Sons Inc. | 卷: | 124 | 期: | 23 | 起(迄)頁: | 4538-4547 | 來源出版物: | Cancer | 摘要: | Background: To eliminate cranial irradiation (CrRT)–related sequelae and to minimize the adverse impact of traumatic lumbar puncture (TLP) with blasts, the Taiwan Pediatric Oncology Group (TPOG) introduced a modified central nervous system (CNS)–directed regimen characterized by delayed triple intrathecal therapy (TIT) and the omission of CrRT for all children with newly diagnosed acute lymphoblastic leukemia (ALL). Methods: This study compared the treatment outcomes of patients overall and patients with a non–CNS-1 status (CNS-2, CNS-3, or TLP with blasts) in 2 treatment eras, one before and another after the revision of the TPOG-ALL-2002 protocol by the introduction of the modification (era 1 [2002-2008] with CrRT and era 2 [2009-2012] with delayed first TIT and no CrRT). Results: There were no statistically significant differences in major outcomes between the 903 patients treated in era 1 and the 444 patients treated in era 2: the 5-year event-free survival (EFS) rates were 75.7% ± 1.4% and 72.1% ± 2.4%, respectively (P =.260), and the cumulative risks of isolated CNS relapse were 4.0% ± 0.7% and 4.1% ± 1.0%, respectively (P =.960). There were also no differences between non–CNS-1 patients treated in era 1 (n = 76) and era 2 (n =28): the 5-year EFS rates were 52.3% ± 5.8% and 62.9% ± 9.4%, respectively (P =.199), and the cumulative risks of isolated CNS relapse were 6.3% ± 3.1% and 3.6% ± 3.5%, respectively (P =.639). Notably, TLP with blasts was completely eliminated after the first TIT was delayed in era 2. Conclusions: The delay of the first TIT until the clearance of circulating blasts and the total omission of CrRT did not compromise survival or CNS control in patients with childhood ALL, including those with a non–CNS-1 status. ? 2018 American Cancer Society |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85054690610&doi=10.1002%2fcncr.31758&partnerID=40&md5=8e306ec8733f2dcab6bea2c2c9ee99cf https://scholars.lib.ntu.edu.tw/handle/123456789/525206 |
ISSN: | 0008-543X | DOI: | 10.1002/cncr.31758 | SDG/關鍵字: | acute lymphoblastic leukemia; Article; cancer recurrence; cancer survival; child; childhood leukemia; comparative study; event free survival; female; follow up; human; major clinical study; male; priority journal; risk factor; skull irradiation; therapy delay; treatment outcome; acute lymphoblastic leukemia; adolescent; adverse event; central nervous system tumor; clinical trial; infant; intraspinal drug administration; newborn; preschool child; procedures; skull irradiation; survival analysis; time to treatment; antineoplastic agent; Adolescent; Antineoplastic Agents; Central Nervous System Neoplasms; Child; Child, Preschool; Cranial Irradiation; Female; Humans; Infant; Infant, Newborn; Injections, Spinal; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Survival Analysis; Time-to-Treatment; Treatment Outcome |
顯示於: | 醫學系 |
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