Childhood high-risk acute lymphoblastic leukemia in first remission: Results after chemotherapy or transplant from the AIEOP ALL 2000 study

Valentino Conter, Maria Grazia Valsecchi, Rosanna Parasole, Maria Caterina Putti, Franco Locatelli, Elena Barisone, Luca Lo Nigro, Nicola Santoro, Maurizio Aricò, Ottavio Ziino, Andrea Pession, Anna Maria Testi, Concetta Micalizzi, Fiorina Casale, Marco Zecca, Gabriella Casazza, Paolo Tamaro, Gaetano La Barba, Lucia Dora Notarangelo, Daniela SilvestriAntonella Colombini, Carmelo Rizzari, Andrea Biondi, Giuseppe Masera, Giuseppe Basso

Research output: Contribution to journalArticle

Abstract

The outcome of high-risk (HR) acute lymphoblastic leukemia patients enrolled in the AIEOP-BFM ALL 2000 study in Italy is described. HR criteria were minimal residual disease (MRD) levels ≥10-3 at day 78 (MRD-HR), no complete remission (CR) at day 33, t(4;11) translocation, andprednisone poor response (PPR).Treatment (2 years) included protocol I, 3 polychemotherapy blocks, delayed intensification (protocol IIx2 or IIIx3), cranial radiotherapy, and maintenance. A total of 312 HR patients had a 5-year event-free survival (EFS) of 58.9%(standard error [SE] = 2.8) and an overall survival of 68.9% (SE = 2.6). In hierarchical order, EFS was 45.9%(4.4) in 132 MRD-HR patients, 41.2%(11.9) in 17 patients with no CR at day 33, 36.4% (14.5) in 11 patients with t(4;11), and 74.0% (3.6) in 152 HR patients only for PPR. No statistically significant difference was found for disease-free survival in patients with very HR features [MRD-HR, no CR at day 33, t(4;11) translocation], given hematopoietic stem cell transplantation (HSCT) (n = 66) or chemotherapy only (n = 88), after adjusting for waiting time to HSCT (5.7 months). Patients at HR only for PPR have a favorable outcome. MRD-HR is associated with poor outcome despite intensive treatment and/or HSCT and may qualify for innovative therapies. The study was registered at www.clinicaltrials.gov as #NCT00613457.

Original languageEnglish
Pages (from-to)1470-1478
Number of pages9
JournalBlood
Volume123
Issue number10
DOIs
Publication statusPublished - Mar 6 2014

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Transplants
Chemotherapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Drug Therapy
Residual Neoplasm
Hematopoietic Stem Cell Transplantation
Stem cells
Disease-Free Survival
Investigational Therapies
Radiotherapy
Combination Drug Therapy
Italy
Maintenance

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

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Childhood high-risk acute lymphoblastic leukemia in first remission : Results after chemotherapy or transplant from the AIEOP ALL 2000 study. / Conter, Valentino; Valsecchi, Maria Grazia; Parasole, Rosanna; Putti, Maria Caterina; Locatelli, Franco; Barisone, Elena; Nigro, Luca Lo; Santoro, Nicola; Aricò, Maurizio; Ziino, Ottavio; Pession, Andrea; Testi, Anna Maria; Micalizzi, Concetta; Casale, Fiorina; Zecca, Marco; Casazza, Gabriella; Tamaro, Paolo; La Barba, Gaetano; Notarangelo, Lucia Dora; Silvestri, Daniela; Colombini, Antonella; Rizzari, Carmelo; Biondi, Andrea; Masera, Giuseppe; Basso, Giuseppe.

In: Blood, Vol. 123, No. 10, 06.03.2014, p. 1470-1478.

Research output: Contribution to journalArticle

Conter, V, Valsecchi, MG, Parasole, R, Putti, MC, Locatelli, F, Barisone, E, Nigro, LL, Santoro, N, Aricò, M, Ziino, O, Pession, A, Testi, AM, Micalizzi, C, Casale, F, Zecca, M, Casazza, G, Tamaro, P, La Barba, G, Notarangelo, LD, Silvestri, D, Colombini, A, Rizzari, C, Biondi, A, Masera, G & Basso, G 2014, 'Childhood high-risk acute lymphoblastic leukemia in first remission: Results after chemotherapy or transplant from the AIEOP ALL 2000 study', Blood, vol. 123, no. 10, pp. 1470-1478. https://doi.org/10.1182/blood-2013-10-532598
Conter, Valentino ; Valsecchi, Maria Grazia ; Parasole, Rosanna ; Putti, Maria Caterina ; Locatelli, Franco ; Barisone, Elena ; Nigro, Luca Lo ; Santoro, Nicola ; Aricò, Maurizio ; Ziino, Ottavio ; Pession, Andrea ; Testi, Anna Maria ; Micalizzi, Concetta ; Casale, Fiorina ; Zecca, Marco ; Casazza, Gabriella ; Tamaro, Paolo ; La Barba, Gaetano ; Notarangelo, Lucia Dora ; Silvestri, Daniela ; Colombini, Antonella ; Rizzari, Carmelo ; Biondi, Andrea ; Masera, Giuseppe ; Basso, Giuseppe. / Childhood high-risk acute lymphoblastic leukemia in first remission : Results after chemotherapy or transplant from the AIEOP ALL 2000 study. In: Blood. 2014 ; Vol. 123, No. 10. pp. 1470-1478.
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T2 - Results after chemotherapy or transplant from the AIEOP ALL 2000 study

AU - Conter, Valentino

AU - Valsecchi, Maria Grazia

AU - Parasole, Rosanna

AU - Putti, Maria Caterina

AU - Locatelli, Franco

AU - Barisone, Elena

AU - Nigro, Luca Lo

AU - Santoro, Nicola

AU - Aricò, Maurizio

AU - Ziino, Ottavio

AU - Pession, Andrea

AU - Testi, Anna Maria

AU - Micalizzi, Concetta

AU - Casale, Fiorina

AU - Zecca, Marco

AU - Casazza, Gabriella

AU - Tamaro, Paolo

AU - La Barba, Gaetano

AU - Notarangelo, Lucia Dora

AU - Silvestri, Daniela

AU - Colombini, Antonella

AU - Rizzari, Carmelo

AU - Biondi, Andrea

AU - Masera, Giuseppe

AU - Basso, Giuseppe

PY - 2014/3/6

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N2 - The outcome of high-risk (HR) acute lymphoblastic leukemia patients enrolled in the AIEOP-BFM ALL 2000 study in Italy is described. HR criteria were minimal residual disease (MRD) levels ≥10-3 at day 78 (MRD-HR), no complete remission (CR) at day 33, t(4;11) translocation, andprednisone poor response (PPR).Treatment (2 years) included protocol I, 3 polychemotherapy blocks, delayed intensification (protocol IIx2 or IIIx3), cranial radiotherapy, and maintenance. A total of 312 HR patients had a 5-year event-free survival (EFS) of 58.9%(standard error [SE] = 2.8) and an overall survival of 68.9% (SE = 2.6). In hierarchical order, EFS was 45.9%(4.4) in 132 MRD-HR patients, 41.2%(11.9) in 17 patients with no CR at day 33, 36.4% (14.5) in 11 patients with t(4;11), and 74.0% (3.6) in 152 HR patients only for PPR. No statistically significant difference was found for disease-free survival in patients with very HR features [MRD-HR, no CR at day 33, t(4;11) translocation], given hematopoietic stem cell transplantation (HSCT) (n = 66) or chemotherapy only (n = 88), after adjusting for waiting time to HSCT (5.7 months). Patients at HR only for PPR have a favorable outcome. MRD-HR is associated with poor outcome despite intensive treatment and/or HSCT and may qualify for innovative therapies. The study was registered at www.clinicaltrials.gov as #NCT00613457.

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