Long-term results of four consecutive trials in childhood ALL performed by the ALL-BFM study group from 1981 to 1995

摘要: Four thousand, four hundred and forty eligible children of up to 18 years age were treated in consecutive trials between 1981 1995 with the treatment protocols Berlin–Frankfurt–Munster (BFM) study group for childhood acute lymphoblastic leukemia (ALL). The probability event-free survival (pEFS) at 8 improved from 65.8% ALL-BFM 81 75.9% 90. cumulative incidence recurrences CNS involvement was 10.1% 9.3% studies 83, but reduced less than 5% 90 (for isolated relapses 5.3% 1.1% 90). major findings derived this series performed by 37 96 centers Germany, Austria, Switzerland: (1) Reintensification is a crucial part treatment, even low risk patients; (2) presymptomatic cranial radiotherapy can be safely 12 Gy, or eliminated if it replaced early intensive systemic intrathecal methotrexate applied; (3) maintenance therapy given total 24 months diagnosis provides lower rate months; (4) inadequate response an initial 7-day prednisone window (combined one injection on day 1) defines about 10% patients very high relapse. For adequate (90% all) 8-year pEFS 80% has been achieved most recent trial While proven so far impossible improve outcome small patients, number could effectively large responding adequately vivo sensitivity test. Apart response, hyperleukocytosis, <1 year, presence Philadelphia-chromosome (Ph+ ALL) are particularly failure.