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Effect of Protracted High-Dose L-Asparaginase Given as a Second Exposure in a Berlin-Frankfurt-Münster–Based Treatment: Results of the Randomized 9102 Intermediate-Risk Childhood Acute Lymphoblastic Leukemia Study—A Report From the Associazione Italiana Ematologia Oncologia Pediatrica

From the Clinica Pediatrica dell’Università di Milano, Ospedale S. Gerardo, Monza; Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia; Ospedale Infantile Regina Margherita, Torino; II Università, Servizio Autonomo di Oncologia Pediatrica, Napoli; Divisione di Onco-Ematologia Pediatrica, Catania; Bologna; Padova; Bari; Cattedra di Ematologia, Università La Sapienza, Roma; and Dipartimento di Medicina e Sanità Pubblica, Università di Verona, Verona, Italy.

Address reprint requests to C. Rizzari, MD, Clinica Pediatrica, Ospedale Nuovo S. Gerardo, Via Donizetti 106, 20052 Monza, Italy; email: masera{at}xquasar.it/gmasera@libero.it

PURPOSE: To assess in a randomized study the therapeutic effect of the addition of high-dose L-asparaginase (HD ASP) in the context of a Berlin-Frankfurt-Münster (BFM)–based chemotherapy regimen for intermediate risk (IR) childhood acute lymphoblastic leukemia (ALL).

PATIENTS AND METHODS: From March 1991 to April 1995, a total of 705 patients, with 59% of the cohort of patients fewer than 15 years old, with newly diagnosed non-B ALL, enrolled onto the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) ALL-91 study, were assigned to the IR group. Patients in remission at the beginning of the reinduction phase were randomized either to the standard treatment (SD ASP arm) or the experimental treatment (HD ASP arm; weekly intramuscular administration of HD ASP 25,000 IU/m² repeated for a total of 20 weeks). Most of the patients (90%) were treated with Erwinia chrysanthemi L-asparaginase product.

RESULTS: Among the 610 patients randomized to the SD ASP arm (n = 322) or to the HD ASP arm (n = 288), relapse occurred at a median time of 24 months after randomization in 76 (24%) and in 64 children (22%), respectively. Most of the relapses occurred in the marrow (100 isolated, 21 combined). There was no significant difference between the disease-free survival in the two treatment arms (P = .64), with estimated values at 7 years from randomization of 72.4% (SE 3.1) v 75.7% (SE 2.6) in the SD ASP and HD ASP arms, respectively.

CONCLUSION: No advantage was observed for IR ALL children treated with BFM-based intensive chemotherapy who received protracted E chrysanthemi HD ASP during reinduction and the early continuation phase.

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