Key treatment questions in childhood acute lymphoblastic leukemia: results in 5 consecutive trials performed by the ALL-BFM study group from 1981 to 2000.

Authors:
M Schrappe, A Möricke, A Reiter, G Henze, K Welte, H Gadner, W-D Ludwig, J Ritter, J Harbott, G Mann, T Klingebiel, B Gruhn, C Niemeyer, B Kremens, F Niggli, K-M Debatin, R Ratei, M Stanulla, R Beier, G Cario, A Schrauder, M Zimmermann
Year of publication:
2013
Volume:
225 Suppl 1
Issue:
-
Issn:
0300-8630
Journal title abbreviated:
KLIN PADIATR
Journal title long:
Klinische Pädiatrie : clinical research and practice in pediatrics
Impact factor:
0.980
Abstract:
Between 1981 and 2000, 6 609 children (<18 years of age) were treated in 5 consecutive trials of the Berlin-Frankfurt-Münster (BFM) study group for childhood acute lymphoblastic leukemia (ALL). Patients were treated in up to 82 centers in Germany, Austria, and Switzerland. Probability of 10-year event-free survival (survival) improved from 65% (77%) in study ALL-BFM 81-78% (85%) in ALL-BFM 95. In parallel to relapse reduction, major efforts focused on reducing acute and late toxicity through advanced risk adaptation of treatment. The major findings derived from these ALL-BFM trials were as follows: 1) preventive cranial radiotherapy could be safely reduced to 12 Gy in T-ALL and high-risk ALL patients and eliminated in non-high-risk non-T-ALL patients, if it was replaced by high-dose and intrathecal methotrexate; 2) omission of delayed reintensification severely impaired outcome of low-risk patients; 3) 6 months less maintenance therapy caused an increase in systemic relapses; 4) slow response to an initial 7-day prednisone window was identified as adverse prognostic factor; 5) condensed induction therapy resulted in a significant improvement of outcome; 6) the daunorubicin dose in induction could be safely reduced in low-risk patients; 7) intensification of consolidation/reintensification treatment led to considerable improvement of outcome in high-risk patients.