CNS‐directed therapy in young children with T‐lineage acute lymphoblastic leukemia: High‐dose methotrexate versus cranial irradiation

Publisher Website
Google Scholar
Abstract
Background: Prophylactic use of cranial radiation therapy (CRT) in young children with acute lymphoblastic leukemia (ALL) is associated with significant long‐term morbidity. Therefore, current treatment protocols for pediatric B‐precursor ALL have abandoned prophylactic CRT in favor of intrathecal chemotherapy, combined with either high‐dose methotrexate infusions (HD‐MTX) or intensive systemic chemotherapy. In contrast, prophylactic CRT continues to be used in children with T‐lineage ALL (T‐ALL), who historically have had an inferior prognosis. We conducted a retrospective cohort study to determine the effect on survival of substituting HD‐MTX for CRT in young children with T‐ALL, a group that faces a high risk of long‐term sequelae from CRT.Procedure: Twenty‐six children, diagnosed with T‐ALL between the ages of 1 and 5 years, were treated on the same high‐risk leukemia protocol. Central nervous system (CNS) directed therapy consisted of either CRT (1,800 cGy) or HD‐MTX (three doses of 8 g/m2), depending on the treatment era in which patients were diagnosed.Results: Of the 24 patients who entered remission, 12 received CRT and 12 received HD‐MTX. Five‐year event‐free survival (EFS) (±SE) was 92 ± 8% in the HD‐MTX group versus 75 ± 13% in the CRT group (P = 0.23). Five‐year overall survival (OS) was 100% in the HD‐MTX group versus 75 ± 13% in the CRT group (P = 0.07). There were no CNS recurrences in the HD‐MTX group. One patient treated with CRT developed a brain tumor.Conclusions: The use of HD‐MTX instead of CRT as CNS‐directed therapy in very young children with T‐ALL does not compromise survival, while avoiding the adverse long‐term effects of cranial irradiation.

This publication has 28 references indexed in Scilit: