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Minimal residual disease-guided treatment deintensilication for children with Acute Lyrnphoblastic Leukemia: results from the Malaysia-Singapore Acuten Lymphobiastic Leukemia 2003 Study

Purpose To improve treatment outcome for childhood acute lymphoblactic leukemia (ALL, we designed the Malaysia-Singapore ALL 2003 study with treatment stratification based on presenting clinical and genetic features and minimal residual disease (MRD) levels measured by polymerase chain reaction tar...

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Main Authors: Yeoh, A.E.J., Ariffin, H., Chai, E.L.L., Kwok, C.S.N., Chan, Y.H., Ponnudurai, K., Campana, D., Tan, P.L., Chan, M.Y., Kham, S.K.Y., Chong, L.A., Tan, A.M., Lin, H.P., Quah, T.C.
Format: Article
Language:English
Published: American Society of Clinical Oncology 2012
Subjects:
R Medicine (General)
Online Access:http://eprints.um.edu.my/10506/1/Minimal_Residual_Disease-Guided_Treatment.pdf
http://eprints.um.edu.my/10506/
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spelling my.um.eprints.105062014-10-14T01:48:56Z http://eprints.um.edu.my/10506/ Minimal residual disease-guided treatment deintensilication for children with Acute Lyrnphoblastic Leukemia: results from the Malaysia-Singapore Acuten Lymphobiastic Leukemia 2003 Study Yeoh, A.E.J. Ariffin, H. Chai, E.L.L. Kwok, C.S.N. Chan, Y.H. Ponnudurai, K. Campana, D. Tan, P.L. Chan, M.Y. Kham, S.K.Y. Chong, L.A. Tan, A.M. Lin, H.P. Quah, T.C. R Medicine (General) Purpose To improve treatment outcome for childhood acute lymphoblactic leukemia (ALL, we designed the Malaysia-Singapore ALL 2003 study with treatment stratification based on presenting clinical and genetic features and minimal residual disease (MRD) levels measured by polymerase chain reaction targeting a single antigen-receptor gene rearrangement. Patients and Methods Five hundred fifty-six patients received risk-adapted therapy with a modified Berlin-Frankfurt-Munster-All treatment. High-risk ALL was defined by MRD ≥ 1 x 10¯³ at week 12 and/or poor prednisolone response, BCR-ABL1, MLL gene rearrangements, hypodiploid less than 45 chromosomes, or induction failure; standard-risk ALL was defined by MRD ≤ 1 x 10¯4 at weeks 5 and 12 and no extramedullary involvement or high-risk features. Intermediate-risk ALL included all remaining patients. Results Patents who lacked high-risk presenting features (85.7%) received remission induction therapy with dexamethasone, vincristine, and asparaginase, without anthracyclines. Six year event-free survival (EFS) was 80.6% ± 3.5%; overall survival was 88.4% ± 3.1%. Standard-risk patients (n=172;31%) received significantly deintensified subsequent therapy without compromising EFS (93.2% ± 4.1%). High-risk patients (n=101;18%) had the worst EFS (51.8% ± 10%); EFS was 83.6% ± 4.9% in intermediate-risk patients (n=283;51%) Conclusion Our results demonstrate significant progress over previous trials in the region. Three-drug remission-induction therapy combined with MRD-based risk stratification to identify poor responders is an effective strategy for chilhood ALL. American Society of Clinical Oncology 2012 Article PeerReviewed application/pdf en http://eprints.um.edu.my/10506/1/Minimal_Residual_Disease-Guided_Treatment.pdf Yeoh, A.E.J. and Ariffin, H. and Chai, E.L.L. and Kwok, C.S.N. and Chan, Y.H. and Ponnudurai, K. and Campana, D. and Tan, P.L. and Chan, M.Y. and Kham, S.K.Y. and Chong, L.A. and Tan, A.M. and Lin, H.P. and Quah, T.C. (2012) Minimal residual disease-guided treatment deintensilication for children with Acute Lyrnphoblastic Leukemia: results from the Malaysia-Singapore Acuten Lymphobiastic Leukemia 2003 Study. Journal of Clinical Oncology, 30 (19). ISSN 0732-183X
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
language English
topic R Medicine (General)
spellingShingle R Medicine (General)
Yeoh, A.E.J.
Ariffin, H.
Chai, E.L.L.
Kwok, C.S.N.
Chan, Y.H.
Ponnudurai, K.
Campana, D.
Tan, P.L.
Chan, M.Y.
Kham, S.K.Y.
Chong, L.A.
Tan, A.M.
Lin, H.P.
Quah, T.C.
Minimal residual disease-guided treatment deintensilication for children with Acute Lyrnphoblastic Leukemia: results from the Malaysia-Singapore Acuten Lymphobiastic Leukemia 2003 Study
description Purpose To improve treatment outcome for childhood acute lymphoblactic leukemia (ALL, we designed the Malaysia-Singapore ALL 2003 study with treatment stratification based on presenting clinical and genetic features and minimal residual disease (MRD) levels measured by polymerase chain reaction targeting a single antigen-receptor gene rearrangement. Patients and Methods Five hundred fifty-six patients received risk-adapted therapy with a modified Berlin-Frankfurt-Munster-All treatment. High-risk ALL was defined by MRD ≥ 1 x 10¯³ at week 12 and/or poor prednisolone response, BCR-ABL1, MLL gene rearrangements, hypodiploid less than 45 chromosomes, or induction failure; standard-risk ALL was defined by MRD ≤ 1 x 10¯4 at weeks 5 and 12 and no extramedullary involvement or high-risk features. Intermediate-risk ALL included all remaining patients. Results Patents who lacked high-risk presenting features (85.7%) received remission induction therapy with dexamethasone, vincristine, and asparaginase, without anthracyclines. Six year event-free survival (EFS) was 80.6% ± 3.5%; overall survival was 88.4% ± 3.1%. Standard-risk patients (n=172;31%) received significantly deintensified subsequent therapy without compromising EFS (93.2% ± 4.1%). High-risk patients (n=101;18%) had the worst EFS (51.8% ± 10%); EFS was 83.6% ± 4.9% in intermediate-risk patients (n=283;51%) Conclusion Our results demonstrate significant progress over previous trials in the region. Three-drug remission-induction therapy combined with MRD-based risk stratification to identify poor responders is an effective strategy for chilhood ALL.
format Article
author Yeoh, A.E.J.
Ariffin, H.
Chai, E.L.L.
Kwok, C.S.N.
Chan, Y.H.
Ponnudurai, K.
Campana, D.
Tan, P.L.
Chan, M.Y.
Kham, S.K.Y.
Chong, L.A.
Tan, A.M.
Lin, H.P.
Quah, T.C.
author_facet Yeoh, A.E.J.
Ariffin, H.
Chai, E.L.L.
Kwok, C.S.N.
Chan, Y.H.
Ponnudurai, K.
Campana, D.
Tan, P.L.
Chan, M.Y.
Kham, S.K.Y.
Chong, L.A.
Tan, A.M.
Lin, H.P.
Quah, T.C.
author_sort Yeoh, A.E.J.
title Minimal residual disease-guided treatment deintensilication for children with Acute Lyrnphoblastic Leukemia: results from the Malaysia-Singapore Acuten Lymphobiastic Leukemia 2003 Study
title_short Minimal residual disease-guided treatment deintensilication for children with Acute Lyrnphoblastic Leukemia: results from the Malaysia-Singapore Acuten Lymphobiastic Leukemia 2003 Study
title_full Minimal residual disease-guided treatment deintensilication for children with Acute Lyrnphoblastic Leukemia: results from the Malaysia-Singapore Acuten Lymphobiastic Leukemia 2003 Study
title_fullStr Minimal residual disease-guided treatment deintensilication for children with Acute Lyrnphoblastic Leukemia: results from the Malaysia-Singapore Acuten Lymphobiastic Leukemia 2003 Study
title_full_unstemmed Minimal residual disease-guided treatment deintensilication for children with Acute Lyrnphoblastic Leukemia: results from the Malaysia-Singapore Acuten Lymphobiastic Leukemia 2003 Study
title_sort minimal residual disease-guided treatment deintensilication for children with acute lyrnphoblastic leukemia: results from the malaysia-singapore acuten lymphobiastic leukemia 2003 study
publisher American Society of Clinical Oncology
publishDate 2012
url http://eprints.um.edu.my/10506/1/Minimal_Residual_Disease-Guided_Treatment.pdf
http://eprints.um.edu.my/10506/
_version_ 1643688817452908544
score 13.211869

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