Cytoreduction and prognosis in acute lymphoblastic leukemia - The importance of early marrow response: Report from the Childrens Cancer Group Journal Article


Authors: Steinherz, P. G.; Gaynon, P. S.; Breneman, J. C.; Cherlow, J. M.; Grossman, N. J.; Kersey, J. H.; Johnstone, H. S.; Sather, H. N.; Trigg, M. E.; Chappell, R.; Hammond, D.; Bleyer, W. A.
Article Title: Cytoreduction and prognosis in acute lymphoblastic leukemia - The importance of early marrow response: Report from the Childrens Cancer Group
Abstract: Purpose: To quantify the residual marrow lymphoblast fraction that best defines patients at high risk for relapse, and the optimal time for assessment during remission induction. Patients and Methods: The residual lymphoblast percentage was evaluated on day 7 (n = 220) and day 14 (n = 205) during a four- or five-drug induction in patients with poor prognostic factors. The rate of cytoreduction was related to event-free survival (EFS) and other factors. Results: On the New York (NY) regimen, 68%, 14%, and 18%, and on the Berlin-Frankfurt-Munster (BFM) regimen, 56%, 15%, and 29% of patients had M1 (< 5% blasts), M2 (5-25%), or M3 (> 25%) responses on day 7 (P = .075). On day 14, the corresponding values were 87%, 6%, 7% on NY and 84%, 8%, 8% on BFM. For patients who achieved remission by day 28 and a day- 7 marrow rating of M1, M2, or M3, the 6-year EFS rate was 78%, 61%, and 49% (P < .001). The day-14 ratings predicted for a 72%, 32%, or 40% EFS (P < .001). Patients with 5% to 10% blasts day 7 had three times as many events as those with less than 5% and had no better EFS than those with 11% to 25% blasts. Patients with a WBC count more than 200,000/μL at diagnosis and an M1 day 7 marrow had an EFS rate of 69%, while for those with M2 or M3, the EFS rate was 41%. Day-7 marrow had greater prognostic significance than the day-14 evaluation. For slow responders on day 7, the day-14 marrow provided additional information. EFS for patients who achieved M1 by day 14 was 65%. EFS decreased to 20% for those still M2 or M3 on day 14. Day-7 and -14 evaluations had significance for patients of all ages and WBC levels. Conclusion: Marrow aspiration on day 7 of therapy provided more useful information than that on day 14. However, day-14 marrow provided additional information for patients with a poor day-7 response. The rate of cytoreduction is a powerful, independent prognostic factor that can identify patients with a slow early response who are at risk for a short remission duration.
Keywords: cancer survival; child; disease-free survival; major clinical study; prednisone; cancer recurrence; cancer risk; combined modality therapy; methotrexate; bone marrow; antineoplastic combined chemotherapy protocols; cyclophosphamide; vincristine; acute lymphoblastic leukemia; risk assessment; cancer regression; bone marrow biopsy; daunorubicin; remission induction; asparaginase; lymphocyte count; leukemia, lymphocytic, acute; humans; prognosis; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 14
Issue: 2
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1996-02-01
Start Page: 389
End Page: 398
Language: English
PUBMED: 8636748
PROVIDER: scopus
DOI: 10.1200/JCO.1996.14.2.389
DOI/URL:
Notes: Article -- Export Date: 22 November 2017 -- Source: Scopus
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MSK Authors
  1. Peter G Steinherz
    162 Steinherz