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Long-Term Results of a Randomized Trial on Extended Use of High Dose L-Asparaginase for Standard Risk Childhood Acute Lymphoblastic Leukemia

From the Associazione Italiana di Ematologia Oncologia Pediatrica (AIEOP); Department of Pediatrics, University of Bologna, Bologna; Medical Statistics Unit, University of Milano-Bicocca, Italy; Department of Pediatrics, University of Milano, Milano; Ospedale San Gerardo, Monza; Center of Pediatric Hematology-Oncology, Università di Catania, Catania; Pediatric Hematology-Oncology, Policlinico San Matteo, Pavia; Department of Pediatrics, University of Padova, Padova; Pediatric Hematology-Oncology, Ospedale dei Bambini G. Di Cristina, Palermo, Italy; the Hungarian Pediatric Hematology Oncology Group (HPOG); Heim Pal Children Hospital, Budapest, Hungary; the Dutch Childhood Oncology Group, the Hague; Beatrix Children's Hospital, Department of Pediatric Oncology, Groningen, the Netherlands

Address reprint requests to Andrea Pession, MD, Oncologia ed Ematologia Pediatrica Clinica Pediatrica Università di Bologna Via Massarenti, 11. I-40138 Bologna, Italy; e-mail: andrea.pession{at}unibo.it

PURPOSE: Between September 1991 and May 1997, within the International Berlin-Frankfurt-Muenster Study Group (I-BFM-SG), a randomized study was performed aimed at assessing the efficacy of prolonged use of high-dose L-asparaginase (HD-L-ASP) during continuation therapy in children with standard risk (SR) acute lymphoblastic leukemia (ALL), treated with a reduced BFM-type chemotherapy.

PATIENTS AND METHODS: The Italian, Dutch, and Hungarian groups participated in this study denominated IDH-ALL-91, and 494 children were enrolled. Treatment consisted of a BFM-type modified backbone with omission of the IB part in induction and elimination of two doses of anthracyclines during reinduction in both arms at the beginning of continuation therapy. Patients were randomly assigned to receive (YES-ASP) or not (NO-ASP) 20 weekly HD-L-ASP (25,000 IU/m²).

RESULTS: The event-free-survival and overall survival probabilities at 10 years for the entire group were 82.5% (1.8) and 90.3% (1.3), respectively. Of the 490 patients eligible for random assignment, 355 (72.4%) were randomly assigned (178 YES-ASP and 177 NO-ASP). After a median follow-up of 9 years, the probability of disease-free survival at 10 years was 87.5% (SE, 2.5) for YES-ASP arm versus 78.7% (SE, 3.3) for NO-ASP arm (P = .03). In multivariate analysis, NO-ASP arm (P = .03), male sex (P = .004), and age older than 10 years (P = .0003) had a significantly adverse impact on outcome.

CONCLUSION: In this subset of patients, selected with criteria not including monitoring of minimal residual disease, application of extended HD-L-ASP may improve prognosis, compensating reduced leukemia control that results from adoption of a reduced-intensity BFM-backbone for treatment of children with SR ALL.

Supported by grants from the Associazione Italiana Ricerca sul Cancro.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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