EQUIVALENCE OF INTRATHECAL CHEMOTHERAPY AND RADIOTHERAPY AS CENTRAL NERVOUS-SYSTEM PROPHYLAXIS IN CHILDREN WITH ACUTE LYMPHATIC-LEUKEMIA - A PEDIATRIC ONCOLOGY GROUP-STUDY

  • 1 January 1982
    • journal article
    • research article
    • Vol. 60  (4) , 948-958
Abstract
The efficacy of intrathecal (i.t.) chemoprophylaxis was compared with cranial radiotherapy plus i.t. methotrexate (MTX) in a study accessing 408 patients. Randomization was stratified by prognostic groups (PG) based on age and white blood cell count at diagnosis. All received induction therapy with vincristine and prednisone (Pred); maintenance therapy consisted of daily 6-mercaptopurine and weekly MTX. Consolidation for arm 1 employed cyclophosphamide and L-asparaginase followed by biweekly 5-day courses of parenteral MTX. The 1st dose of each course of MTX was given i.t. in triple chemoprophylaxis (MTX, hydrocortisone, and cytosine arabinoside). During maintenance, i.t. chemoprophylaxis was bimonthly and 28-day Pred pulses were given every 3 mo. Arm 2 i.t. chemoprophylaxis was initiated on achievement of remission, and arm 3 i.t. on treatment day 1; both continued 1 yr. Arm 4 induction included 2 doses of L-asparaginase. On achievement of remission, CNS prophylaxis (radiotherapy, 2400 rad plus i.t. MTX) was given. Therapy was discontinued after 3 yr of continuous complete remission. Survival and the incidence of extramedullary relapse for the treatments were compared. I.t. chemoprophylaxis may be substituted for cranial radiotherapy when utilizing effective systemic regimens. Chemoprophylaxis may be reduced from 3 to 1 yr in patients with good prognostic factors.