Long-term results of a randomized trial on extended use of high dose L-asparaginase for standard risk childhood acute lymphoblastic leukemia

Andrea Pession, Maria Grazia Valsecchi, Giuseppe Masera, Willem A. Kamps, Edina Magyarosy, Carmelo Rizzari, Elisabeth R. Van Wering, Luca Lo Nigro, Anna Van Der Does, Franco Locatelli, Giuseppe Basso, Maurizio Aricò

Research output: Contribution to journalArticlepeer-review


Purpose: Between September 1991 and May 1997, within the International Berlin-Frankfurt-Muenster Study Group (I-BFM-SG), a randomized study was performed aimed at assessing the efficacy of prolonged use of high-dose L-asparaginase (HD-L-ASP) during continuation therapy in children with standard risk (SR) acute lymphoblastic leukemia (ALL), treated with a reduced BFM-type chemotherapy. Patients and Methods: The Italian, Dutch, and Hungarian groups participated in this study denominated IDH-ALL-91, and 494 children were enrolled. Treatment consisted of a BFM-type modified backbone with omission of the IB part in induction and elimination of two doses of anthracyclines during reinduction in both arms at the beginning of continuation therapy. Patients were randomly assigned to receive (YES-ASP) or not (NO-ASP) 20 weekly HD-L-ASP (25,000 IU/m2). Results: The event-free-survival and overall survival probabilities at 10 years for the entire group were 82.5% (1.8) and 90.3% (1.3), respectively. Of the 490 patients eligible for random assignment, 355 (72.4%) were randomly assigned (178 YES-ASP and 177 NO-ASP). After a median follow-up of 9 years, the probability of disease-free survival at 10 years was 87.5% (SE, 2.5) for YES-ASP arm versus 78.7% (SE, 3.3) for NO-ASP arm (P = .03). In multivariate analysis, NO-ASP arm (P = .03), male sex (P = .004), and age older than 10 years (P = .0003) had a significantly adverse impact on outcome. Conclusion: In this subset of patients, selected with criteria not including monitoring of minimal residual disease, application of extended HD-L-ASP may improve prognosis, compensating reduced leukemia control that results from adoption of a reduced-intensity BFM-backbone for treatment of children with SR ALL.

Original languageEnglish
Pages (from-to)7161-7167
Number of pages7
JournalJournal of Clinical Oncology
Issue number28
Publication statusPublished - 2005

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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