TY - JOUR
T1 - Intensified PEG-L-asparaginase and antimetabolite-based therapy for treatment of higher risk precursor-B acute lymphoblastic leukemia
T2 - A report from the children's oncology group
AU - Salzer, Wanda L.
AU - Devidas, Meenakshi
AU - Shuster, Jonathan J.
AU - Wang, Chenguang
AU - Chauvenet, Allen
AU - Asselin, Barbara L.
AU - Camitta, Bruce M.
AU - Kurtzberg, Joanne
PY - 2007/6
Y1 - 2007/6
N2 - The Pediatric Oncology Group 9203 pilot protocol was designed to determine the feasibility of delivering 29 biweekly doses of polyethylene glycol (PEG)-L-asparaginase, on a backbone of intensive multiagent antimetabolite-based consolidation and maintenance in higher risk B-precursor acute lymphoblastic leukemia. Between June 1992 and August 1993, 34 patients were enrolled on this limited institution pilot. The 5-year event-free survival (±standard error) and overall survival (±standard error) were 68±8% and 76±7%, respectively. Excessive toxicities attributed to PEG-L-asparaginase and myelosuppression associated with cytosine arabinoside were encountered during consolidation resulting in early study closure and modification of therapy for those already enrolled. Ninety-two percent of methotrexate/cytosine arabinoside cycles were associated with grades 3 to 4 myelosuppression, and 24% resulted in delays in therapy of more than 7 days. Fifteen PEG-L-asparaginase related toxicities occurred in 13 patients (8 allergy, 4 pancreas, 2 central nervous system, and 1 hemorrhage). Intensification of therapy with PEG-L-asparaginase resulted in event-free survival and overall survival comparable to other studies of the same time period without the use of agents associated with long-term complications, such as anthracyclines, epipodophyllotoxins, and alkylating agents. However, excessive toxicity occurred with intensified PEG-L-asparaginase and antimetabolite based therapy delivered on this schedule.
AB - The Pediatric Oncology Group 9203 pilot protocol was designed to determine the feasibility of delivering 29 biweekly doses of polyethylene glycol (PEG)-L-asparaginase, on a backbone of intensive multiagent antimetabolite-based consolidation and maintenance in higher risk B-precursor acute lymphoblastic leukemia. Between June 1992 and August 1993, 34 patients were enrolled on this limited institution pilot. The 5-year event-free survival (±standard error) and overall survival (±standard error) were 68±8% and 76±7%, respectively. Excessive toxicities attributed to PEG-L-asparaginase and myelosuppression associated with cytosine arabinoside were encountered during consolidation resulting in early study closure and modification of therapy for those already enrolled. Ninety-two percent of methotrexate/cytosine arabinoside cycles were associated with grades 3 to 4 myelosuppression, and 24% resulted in delays in therapy of more than 7 days. Fifteen PEG-L-asparaginase related toxicities occurred in 13 patients (8 allergy, 4 pancreas, 2 central nervous system, and 1 hemorrhage). Intensification of therapy with PEG-L-asparaginase resulted in event-free survival and overall survival comparable to other studies of the same time period without the use of agents associated with long-term complications, such as anthracyclines, epipodophyllotoxins, and alkylating agents. However, excessive toxicity occurred with intensified PEG-L-asparaginase and antimetabolite based therapy delivered on this schedule.
KW - Antimetabolite
KW - Asparaginase
KW - Childhood acute lymphoblastic leukemia
UR - http://www.scopus.com/inward/record.url?scp=34250018555&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34250018555&partnerID=8YFLogxK
U2 - 10.1097/MPH.0b013e3180640d54
DO - 10.1097/MPH.0b013e3180640d54
M3 - Article
C2 - 17551397
AN - SCOPUS:34250018555
SN - 1077-4114
VL - 29
SP - 369
EP - 375
JO - Journal of Pediatric Hematology/Oncology
JF - Journal of Pediatric Hematology/Oncology
IS - 6
ER -