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Effective VCR/DEX pulse maintenance therapy in the KYCCSG ALL-02 protocol for pediatric acute lymphoblastic leukemia

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Abstract

In a previous study of childhood acute lymphoblastic leukemia (ALL) by the Kyushu–Yamaguchi Children’s Cancer Study Group, ALL-96, we achieved a 72.1 % 5-year event-free survival (EFS) and an 84.8 % 5-year overall survival (OS). In a subsequent study, ALL-02, we adopted a vincristine dexamethasone (VCR/DEX) pulse regimen as maintenance therapy in the context of the ALL-96 study using the same risk classification and treatment schedule. A total of 156 pediatric cases of ALL were treated with ALL-02. All of the patients were classified as standard-risk or high-risk. Risk stratification was based on white cell counts, immunophenotype, the presence of central nervous system (CNS) disease at diagnosis, organomegaly, and early treatment response (day 14 bone marrow status). The 7-year EFS and OS rates were 77.7 % (95 % CI 70.6–84.8 %) and 89.5 % (95 % CI 84.6–94.4 %), respectively. CNS 3 status [hazard ratio (HR) = 5.0, p = 0.009] and high white blood cell count at diagnosis (HR = 2.6, p = 0.047) were risk factors for poor EFS in multivariate analysis. Our strategies to categorize patients into two risk groups, and to treat with a VCR/DEX pulse were feasible and reasonably effective treatments for pediatric ALL.

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Acknowledgments

We would like to show out great appreciation to Dr. Jun Okamura and Dr. Akinobu Matsuzaki, whose comments and suggestions were innumerably valuable throughout the course of our study, and Dr. Yoshihisa Nagatoshi and Dr. Aiko Suminoe, whose contribution were valuable in the design of our study. This work was supported by the Children’s Cancer Association of Japan.

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Authors and Affiliations

  1. Department of Pediatrics, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Yasuhiro Okamoto, Takayuki Tanabe & Yoshifumi Kawano

  2. Department of Pediatrics, Kyushu University, Fukuoka, Japan

    Yuki Koga & Kentaro Nakashima

  3. Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan

    Jiro Inagaki & Reiji Fukano

  4. Department of Pediatrics, Kurume University, Kurume, Japan

    Shuichi Ozono & Koichiro Ueda

  5. Department of Pediatrics, Yamaguchi University, Yamaguchi, Japan

    Maiko Shimoura

  6. Department of Pediatrics, Ohita Prefectural Hospital, Ohita, Japan

    Nobuyoshi Itonaga

  7. Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan

    Yuichi Shinkoda

  8. Division of Pediatrics, University of Miyazaki, Miyazaki, Japan

    Hiroshi Moritake

  9. Department of Pediatrics, Fukuoka University, Fukuoka, Japan

    Yuko Nomura

  10. Department of Pediatrics, Fukuoka Higashi Medical Center, Fukuoka, Japan

    Hideki Nakayama

  11. Department of Pediatrics, Tokuyama City Hospital, Shunan, Japan

    Noriko Hotta

  12. Department of Pediatrics, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

    Yasufumi Hidaka

  13. Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan

    Hidemi Shimonodan

  14. Department of Pediatrics, Beppu Medical Center, Beppu, Japan

    Naohiro Suga

Authors
  1. Yasuhiro Okamoto
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  2. Yuki Koga
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  3. Jiro Inagaki
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  4. Shuichi Ozono
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  5. Koichiro Ueda
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  6. Maiko Shimoura
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  7. Nobuyoshi Itonaga
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  8. Yuichi Shinkoda
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  9. Hiroshi Moritake
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  10. Yuko Nomura
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  11. Hideki Nakayama
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  12. Noriko Hotta
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  13. Yasufumi Hidaka
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  14. Hidemi Shimonodan
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  15. Naohiro Suga
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  16. Takayuki Tanabe
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  17. Kentaro Nakashima
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  18. Reiji Fukano
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  19. Yoshifumi Kawano
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Corresponding author

Correspondence to Yasuhiro Okamoto.

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Conflict of interest

The authors declare no relevant conflicts of interest, except for research funding from Children’s Cancer Association of Japan.

Participating institutions

Yamaguchi University; Tokuyama City Hospital, Tokuyama; Pediatrics, Tokuyama City Hospital, Shunan, Japan; Department of Pediatrics, Kitakyushu City Medical Center, Kitakyushu; Pediatrics, Fukuoka Higashi Medical Center, Japan; Section of Pediatrics, Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka; Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Pediatrics, Fukuoka University, Fukuoka; Department of Pediatrics, Hamanomachi Hospital, Fukuoka; Pediatrics and Child Health, Kurume University School of Medicine, Kurume; Department of Pediatrics, Graduate School of Medicine, Ohita University, Ohita; Department of Pediatrics, Oita Prefectural Hospital, Oita; Pediatrics, Beppu Medical Center, Japan; Department of Pediatrics, Faculty of Medicine, Miyazaki University, Miyazaki; Department of Pediatrics, Miyazaki Prefectural Hospital, Miyazaki; Department of Pediatrics, Kagoshima City Hospital, Kagoshima.

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Okamoto, Y., Koga, Y., Inagaki, J. et al. Effective VCR/DEX pulse maintenance therapy in the KYCCSG ALL-02 protocol for pediatric acute lymphoblastic leukemia. Int J Hematol 103, 202–209 (2016). https://doi.org/10.1007/s12185-015-1910-1

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  • DOI: https://doi.org/10.1007/s12185-015-1910-1

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