INFLUENCE OF INTENSIVE ASPARAGINASE IN THE TREATMENT OF CHILDHOOD NON-T-CELL ACUTE LYMPHOBLASTIC-LEUKEMIA

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  • 1 January 1983
    • journal article
    • research article
    • Vol. 43  (11) , 5601-5607
Abstract
Between June 1977 and Dec. 1979, 72 evaluable patients with childhood non-T cell acute lymphoblastic leukemia were induced into complete remission using vincristine, prednisone and doxorubicin. All received asparaginase consolidation and CNS prophylaxis with cranial irradiation and intrathecal methotrexate. All patients then received prolonged intensification with vincristine, prednisone and doxorubicin, and half of them were randomized to receive weekly high-dose asparaginase. Continuation therapy was with vincristine, prednisone, methotrexate and 6-mercaptopurine. After a median follow-up of 57 mo., there were 4 remission deaths and 25 relapses. CNS relapse was the 1st event in 4% of patients. There were fewer treatment failures in the asparaginase-treated group [2-sided, P = 0.04 (0.07 controlling for standard and high-risk groups)]. Asparaginase toxicity occurred in 6 patients (8%) and was self-limited, but it precluded further use of the drug in those patients. The major toxicity of this treatment program was drug-induced cardiomyopathy which occurred in 10 patients (14%) and was fatal in 3 of them. The intensive use of high-dose asparaginase has an important role in the treatment of children with acute lymphoblastic leukemia. The morbidity of multiple doses of doxorubicin outweighed its antileukemic advantage in standard-risk patients.