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Journal of Clinical Oncology, Vol 14, 18-24, Copyright © 1996 by American Society of Clinical Oncology

ARTICLES

Uniform approach to risk classification and treatment assignment for children with acute lymphoblastic leukemia

M Smith, D Arthur, B Camitta, AJ Carroll, W Crist, P Gaynon, R Gelber, N Heerema, EL Korn, M Link, S Murphy, CH Pui, J Pullen, G Reamon, SE Sallan, H Sather, J Shuster, R Simon, M Trigg, D Tubergen, F Uckun and R Ungerleider
Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD 20892, USA.

PURPOSE: To define more uniform criteria for risk-based treatment assignment for children with acute lymphoblastic leukemia (ALL), the Cancer Therapy Evaluation Program (CTEP) of the National Cancer Institute (NCI) sponsored a workshop in September 1993. Participants included representatives from the Childrens Cancer Group (CCG), Pediatric Oncology Group (POG), Dana-Farber Cancer Institute (DFCI), St Jude Children's Research Hospital (SJCRH), and the CTEP. METHODS: Workshop participants presented and reviewed data from ALL clinical trials, using weighted averages to combine outcome data from different groups. RESULTS: For patients with B-precursor (ie, non-T, non-B) ALL, the standard-risk category (4-year event-free survival [EFS] rate, approximately 80%) will include patients 1 to 9 years of age with a WBC count at diagnosis less than 50,000/microL. The remaining patients will be classified as having high-risk ALL (4-year EFS rate, approximately 65%). For patients with T-cell ALL, different treatment strategies have yielded different conclusions concerning the prognostic significance of T-cell immunophenotype. Therefore, some groups/institutions will classify patients with T-cell ALL as high risk, while others will assign risk for patients with T-cell ALL based on the uniform age/WBC count criteria. Workshop participants agreed that the risk category of a patient may be modified by prognostic factors in addition to age and WBC count criteria, and that a common set of prognostic factors should be uniformly obtained, including DNA index (DI), cytogenetics, early response to treatment (eg, day-14 bone marrow), immunophenotype, and CNS status. CONCLUSIONS: The more uniform approach to risk-based treatment assignment and to collection of specific prognostic factors should increase the efficiency of future ALL clinical research.
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[Abstract] [Full Text] [PDF]

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 NEJMHome page
J. Donadieu, C. Hill, J. B. Nachman, H. N. Sather, and P. S. Gaynon
Augmented Post-Induction Therapy in Childhood Lymphoblastic Leukemia
N. Engl. J. Med., October 8, 1998; 339(15): 1080 - 1081.
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C.-H. Pui and W. E. Evans
Acute Lymphoblastic Leukemia
N. Engl. J. Med., August 27, 1998; 339(9): 605 - 615.
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M. C. Putti, R. Rondelli, M. G. Cocito, M. Arico, L. Sainati, V. Conter, C. Guglielmi, A. Cantu-Rajnoldi, R. Consolini, A. Pession, et al.
Expression of Myeloid Markers Lacks Prognostic Impact in Children Treated for Acute Lymphoblastic Leukemia: Italian Experience in AIEOP-ALL 88-91 Studies
Blood, August 1, 1998; 92(3): 795 - 801.
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F. M. Uckun, K. Herman-Hatten, M.-L. Crotty, M. G. Sensel, H. N. Sather, L. Tuel-Ahlgren, M. B. Sarquis, B. Bostrom, J. B. Nachman, P. G. Steinherz, et al.
Clinical Significance of MLL-AF4 Fusion Transcript Expression in the Absence of a Cytogenetically Detectable t(4;11)(q21;q23) Chromosomal Translocation
Blood, August 1, 1998; 92(3): 810 - 821.
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E. Green, C. M. McConville, J. E. Powell, J. R. Mann, P. J. Darbyshire, A. M. R. Taylor, and T. Stankovic
Clonal Diversity of Ig and T-Cell-Receptor Gene Rearrangements Identifies a Subset of Childhood B-Precursor Acute Lymphoblastic Leukemia With Increased Risk of Relapse
Blood, August 1, 1998; 92(3): 952 - 958.
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K. Seeger, H.-P. Adams, D. Buchwald, B. Beyermann, B. Kremens, C. Niemeyer, J. Ritter, D. Schwabe, D. Harms, M. Schrappe, et al.
TEL-AML1 Fusion Transcript in Relapsed Childhood Acute Lymphoblastic Leukemia
Blood, March 1, 1998; 91(5): 1716 - 1722.
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F. M. Uckun, M. G. Sensel, L. Sun, P. G. Steinherz, M. E. Trigg, N. A. Heerema, H. N. Sather, G. H. Reaman, and P. S. Gaynon
Biology and Treatment of Childhood T-Lineage Acute Lymphoblastic Leukemia
Blood, February 1, 1998; 91(3): 735 - 746.
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 The OncologistHome page
J. E. Rubnitz and C.-H. Pui
Childhood Acute Lymphoblastic Leukemia
Oncologist, December 1, 1997; 2(6): 374 - 380.
[Abstract] [Full Text] [PDF]

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J. H. Kersey
Fifty Years of Studies of the Biology and Therapy of Childhood Leukemia
Blood, December 1, 1997; 90(11): 4243 - 4251.
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S.C. Raimondi, S.A. Shurtleff, J.R. Downing, J. Rubnitz, S. Mathew, M. Hancock, C-H. Pui, G.K. Rivera, G.C. Grosveld, and F.G. Behm
12p Abnormalities and the TEL Gene (ETV6) in Childhood Acute Lymphoblastic Leukemia
Blood, December 1, 1997; 90(11): 4559 - 4566.
[Abstract] [Full Text] [PDF]

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S. P. Dibenedetto, L. Lo Nigro, S. Pine Mayer, G. Rovera, and G. Schiliro
Detectable Molecular Residual Disease at the Beginning of Maintenance Therapy Indicates Poor Outcome in Children With T-Cell Acute Lymphoblastic Leukemia
Blood, August 1, 1997; 90(3): 1226 - 1232.
[Abstract] [Full Text] [PDF]

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L. H. Matherly, J. W. Taub, S. C. Wong, P. M. Simpson, R. Ekizian, S. Buck, M. Williamson, M. Amylon, J. Pullen, B. Camitta, et al.
Increased Frequency of Expression of Elevated Dihydrofolate Reductase in T-Cell Versus B-Precursor Acute Lymphoblastic Leukemia in Children
Blood, July 15, 1997; 90(2): 578 - 589.
[Abstract] [Full Text] [PDF]

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F. M. Uckun, H. N. Sather, P. S. Gaynon, D. C. Arthur, M. E. Trigg, D. G. Tubergen, J. Nachman, P. G. Steinherz, M. G. Sensel, and G. H. Reaman
Clinical Features and Treatment Outcome of Children With Myeloid Antigen Positive Acute Lymphoblastic Leukemia: A Report From the Children's Cancer Group
Blood, July 1, 1997; 90(1): 28 - 35.
[Abstract] [Full Text] [PDF]

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M. J. Borowitz, J. Shuster, A. J. Carroll, M. Nash, A. T. Look, B. Camitta, D. Mahoney, S. J. Lauer, and D. J. Pullen
Prognostic Significance of Fluorescence Intensity of Surface Marker Expression in Childhood B-Precursor Acute Lymphoblastic Leukemia. A Pediatric Oncology Group Study
Blood, June 1, 1997; 89(11): 3960 - 3966.
[Abstract] [Full Text] [PDF]

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U. R. Kees, P. R. Burton, C. Lu, and D. L. Baker
Homozygous Deletion of the p16/MTS1 Gene in Pediatric Acute Lymphoblastic Leukemia Is Associated With Unfavorable Clinical Outcome
Blood, June 1, 1997; 89(11): 4161 - 4166.
[Abstract] [Full Text] [PDF]

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F. M. Uckun, Z. Yang, H. Sather, P. Steinherz, J. Nachman, B. Bostrom, L. Crotty, M. Sarquis, O. Ek, T. Zeren, et al.
Cellular Expression of Antiapoptotic BCL-2 Oncoprotein in Newly Diagnosed Childhood Acute Lymphoblastic Leukemia: A Children's Cancer Group Study
Blood, May 15, 1997; 89(10): 3769 - 3777.
[Abstract] [Full Text] [PDF]

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J. M. Hilden, F. O. Smith, J. L. Frestedt, R. McGlennen, W. B. Howells, P. H.B. Sorensen, D. C. Arthur, W. G. Woods, J. Buckley, I. D. Bernstein, et al.
MLL Gene Rearrangement, Cytogenetic 11q23 Abnormalities, and Expression of the NG2 Molecule in Infant Acute Myeloid Leukemia
Blood, May 15, 1997; 89(10): 3801 - 3805.
[Abstract] [Full Text] [PDF]

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F. M. Uckun, P. Gaynon, H. Sather, D. Arthur, M. Trigg, D. Tubergen, J. Nachman, P. Steinherz, M. G. Sensel, and G. R. Reaman
Clinical Features and Treatment Outcome of Children With Biphenotypic CD2+CD19+ Acute Lymphoblastic Leukemia: A Children's Cancer Group Study
Blood, April 1, 1997; 89(7): 2488 - 2493.
[Abstract] [Full Text] [PDF]

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J. E. Rubnitz, J. J. Shuster, V. J. Land, M. P. Link, D. J. Pullen, B. M. Camitta, C.-H. Pui, J. R. Downing, and F. G. Behm
Case-Control Study Suggests a Favorable Impact of TEL Rearrangement in Patients With B-Lineage Acute Lymphoblastic Leukemia Treated With Antimetabolite-Based Therapy: A Pediatric Oncology Group Study
Blood, February 15, 1997; 89(4): 1143 - 1146.
[Abstract] [Full Text] [PDF]

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W. M. Roberts, Z. Estrov, M. V. Ouspenskaia, D. A. Johnston, K. L. McClain, and T. F. Zipf
Measurement of Residual Leukemia during Remission in Childhood Acute Lymphoblastic Leukemia
N. Engl. J. Med., January 30, 1997; 336(5): 317 - 323.
[Abstract] [Full Text] [PDF]


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