Journal of Clinical Oncology, Vol 11, 279-286, Copyright © 1993 by American Society of Clinical Oncology
Does cranial irradiation reduce the risk for bone marrow relapse in acute myelogenous leukemia? Unexpected results of the Childhood Acute Myelogenous Leukemia Study BFM-87
U Creutzig, J Ritter, M Zimmermann and G Schellong
University Children's Hospital, Munster, Germany.
PURPOSE: One of the goals of study AMA-BFM-87 was to test prospectively in
acute myelogenous leukemia (AML) patients if cranial irradiation could be
replaced by late intensification therapy with high-dose cytarabine (Ara-C)
and etoposide (VP-16). PATIENTS AND METHODS: Patients with a low risk of
CNS relapses (ie, no initial CNS disease, WBC count at diagnosis < or =
70.000/microL) were randomized for irradiation (group A, 31 patients). In
25 patients (group B), randomization was refused. As interim results showed
no increase of CNS relapses in nonirradiated patients, prophylactic
irradiation was discontinued after 2 1/2 years to prevent unnecessary CNS
toxicity. Forty-four patients (group C) entered the study after
randomization had been stopped. RESULTS: In all patients with a low risk of
CNS recurrences (n = 100), a significantly higher probability of relapse-
free interval (pRFI) of 5 years was found in irradiated patients (pRFI =
.78) compared with nonirradiated patients (pRFI = .41) (P = .007).
Moreover, a slightly higher incidence of CNS relapses was observed in
nonirradiated patients. Due to the small number of patients, this was not
observed when randomized patients only were analyzed. In accordance with
these findings, the favorable outcome of low-risk patients in the preceding
study, AML-BFM-83 (pRFI > .80), could only be reproduced in study
AML-BFM-87 in patients who had received cranial irradiation. CONCLUSION:
These results indicate that cranial irradiation should be an integral part
of the treatment of all AML patients not undergoing bone marrow
transplantation. Residual blasts in the CNS may escape systemic
chemotherapy and lead to recurrence of the initial disease not only in the
CNS, but also in the bone marrow.
This article has been cited by other articles:
|
|
|
|
 
B. Burkhardt, W. Woessmann, M. Zimmermann, U. Kontny, J. Vormoor, W. Doerffel, G. Mann, G. Henze, F. Niggli, W.-D. Ludwig, et al.
Impact of Cranial Radiotherapy on Central Nervous System Prophylaxis in Children and Adolescents With Central Nervous System-Negative Stage III or IV Lymphoblastic Lymphoma
J. Clin. Oncol.,
January 20, 2006;
24(3):
491 - 499.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. E. Vist, K. B. Hagen, P J Devereaux, D. Bryant, D. T. Kristoffersen, and A. D. Oxman
Systematic review to determine whether participation in a trial influences outcome
BMJ,
May 21, 2005;
330(7501):
1175.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. Zwaan, S. Meshinchi, J. P. Radich, A. J. P. Veerman, D. R. Huismans, L. Munske, M. Podleschny, K. Hahlen, R. Pieters, M. Zimmermann, et al.
FLT3 internal tandem duplication in 234 children with acute myeloid leukemia: prognostic significance and relation to cellular drug resistance
Blood,
October 1, 2003;
102(7):
2387 - 2394.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Wells, M. T. Adams, T. A. Alonzo, R. J. Arceci, J. Buckley, A. B. Buxton, K. Dusenbery, A. Gamis, M. Masterson, T. Vik, et al.
Mitoxantrone and Cytarabine Induction, High-Dose Cytarabine, and Etoposide Intensification for Pediatric Patients With Relapsed or Refractory Acute Myeloid Leukemia: Children's Cancer Group Study 2951
J. Clin. Oncol.,
August 1, 2003;
21(15):
2940 - 2947.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Perel, A. Auvrignon, T. Leblanc, J.-P. Vannier, G. Michel, B. Nelken, V. Gandemer, C. Schmitt, J.-P. Lamagnere, L. De Lumley, et al.
Impact of Addition of Maintenance Therapy to Intensive Induction and Consolidation Chemotherapy for Childhood Acute Myeloblastic Leukemia: Results of a Prospective Randomized Trial, LAME 89/91
J. Clin. Oncol.,
June 15, 2002;
20(12):
2774 - 2782.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Pinkel, W. G. Woods, B. J. Lange, F. O. Smith, and T. A. Alonzo
Treatment of children with acute myeloid leukemia
Blood,
June 1, 2001;
97(11):
3673 - 3675.
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Creutzig, J. Ritter, M. Zimmermann, D. Reinhardt, J. Hermann, F. Berthold, G. Henze, H. Jurgens, H. Kabisch, W. Havers, et al.
Improved Treatment Results in High-Risk Pediatric Acute Myeloid Leukemia Patients After Intensification With High-Dose Cytarabine and Mitoxantrone: Results of Study Acute Myeloid Leukemia-Berlin-Frankfurt-Munster 93
J. Clin. Oncol.,
May 15, 2001;
19(10):
2705 - 2713.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Bonetti, M. Zecca, A. Pession, C. Messina, D. Montagna, E. Lanino, F. Fagioli, N. Santoro, A. Prete, S. Cesaro, et al.
Total-Body Irradiation and Melphalan Is a Safe and Effective Conditioning Regimen for Autologous Bone Marrow Transplantation in Children With Acute Myeloid Leukemia in First Remission
J. Clin. Oncol.,
December 1, 1999;
17(12):
3729 - 3735.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Jaju, O. A. Haas, M. Neat, J. Harbott, V. Saha, J. Boultwood, J. M. Brown, H. Pirc-Danoewinata, B. W. Krings, U. Muller, et al.
A New Recurrent Translocation, t(5;11)(q35;p15.5), Associated With del(5q) in Childhood Acute Myeloid Leukemia
Blood,
July 15, 1999;
94(2):
773 - 780.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J L Craze, G Harrison, K Wheatley, I M Hann, and J M Chessells
Improved outcome of acute myeloid leukaemia in Down's syndrome
Arch. Dis. Child.,
July 1, 1999;
81(1):
32 - 37.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
C.-H. Pui
Childhood Leukemias
N. Engl. J. Med.,
June 15, 1995;
332(24):
1618 - 1630.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Media Review
Journal of Pediatric Oncology Nursing,
January 1, 1993;
10(3):
119 - 123.
[PDF]
|
|
|
|
