Isolated central nervous system relapse following treatment reduction in low-risk acute lymphoblastic leukemia at the children's cancer center of lebanon
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Lippincott Williams and Wilkins
Abstract
The aim of this trial was to decrease the incidence of life-threatening infections by decreasing the dose and the duration of dexamethasone treatment during maintenance therapy. This was a prospective, nonrandomized trial of low-risk acute lymphoblastic leukemia patients 1 to 18 years of age who were treated at the Children's Cancer Center of Lebanon (CCCL). Patients consecutively diagnosed between 2002 and 2013 were divided into groups 1 and 2 receiving total dexamethasone doses of 1144 and 618 mg/m2, respectively. A total of 84 patients were assigned to group 1 and 33 patients to group 2. The 5-year cumulative incidence of isolated central nervous system relapse increased from (n=0% [95% confidence interval: 0%-4.4%]) in group 1 to 9.1% [95% confidence interval: 3%-23%]; P=0.021) in group 2. Decreasing cumulative dose of dexamethasone for low-risk childhood acute lymphoblastic leukemia patients aiming to avoid serious viral infections led to a significant increase in isolated central nervous system relapse. © 2020 Lippincott Williams and Wilkins. All rights reserved.
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Childhood acute lymphoblastic leukemia, Decreasing dexamethasone dose, Isolated cns relapse, Lebanon, Adolescent, Antineoplastic combined chemotherapy protocols, Case-control studies, Central nervous system neoplasms, Child, Child, preschool, Dexamethasone, Dose-response relationship, drug, Female, Follow-up studies, Humans, Incidence, Infant, Male, Methotrexate, Neoplasm recurrence, local, Non-randomized controlled trials as topic, Precursor cell lymphoblastic leukemia-lymphoma, Prognosis, Prospective studies, Survival rate, Asparaginase, Cyclophosphamide, Cytarabine, Daunorubicin, Doxorubicin, Mercaptopurine, Prednisone, Vincristine, Antineoplastic agent, Acute lymphoblastic leukemia, Adult, Article, Cancer risk, Central nervous system disease, Drug dose reduction, Drug megadose, Drug withdrawal, Human, Isolated central nervous system relapse, Life threat, Low risk patient, Maintenance therapy, Major clinical study, Multiple cycle treatment, Pediatric hospital, Priority journal, Prospective study, Treatment duration, Virus infection, Case control study, Central nervous system tumor, Controlled clinical trial (topic), Dose response, Follow up, Pathology, Preschool child, Tumor recurrence