Results of successive EORTC-CLG 58 881 and 58 951 trials in paediatric T-cell acute lymphoblastic leukaemia (ALL) - Université de Montpellier Accéder directement au contenu
Article Dans Une Revue British Journal of Haematology Année : 2019

Results of successive EORTC-CLG 58 881 and 58 951 trials in paediatric T-cell acute lymphoblastic leukaemia (ALL)

Mattias Hofmans
  • Fonction : Auteur
Alina Ferster
Vitor Costa
  • Fonction : Auteur
Karima Yakouben
  • Fonction : Auteur
Jutte van Der Werff Ten Bosch
  • Fonction : Auteur
Odile Minckes
  • Fonction : Auteur
Pierre Rohrlich
  • Fonction : Auteur
Hélène Cavé
  • Fonction : Auteur
Barbara de Moerloose
  • Fonction : Auteur

Résumé

Outcomes in childhood T‐cell acute lymphoblastic leukaemia (T‐ALL) are steadily improving due to intensive therapy. Between 1989 and 2008, 599 children with newly diagnosed T‐ALL were enrolled in two successive European Organization for Research and Treatment of Cancer ‐ Children's Leukaemia Group trials (58881 and 58951), both based on the Berlin‐Frankfurt‐Munster protocol and without cranial irradiation. In the latter trial induction chemotherapy was intensified. The most important randomizations were Medac Escherichia coli asparaginase versus Erwinia asparaginase in trial 58881, and dexamethasone (6 mg/m2/day) versus prednisolone (60 mg/m2/day) and prolonged versus conventional asparaginase duration in trial 58951. 8‐year event‐free survival (EFS) increased from 65·1% to 74·0% in trial 58951. Improvement was most profound for patients with white blood cell (WBC) counts <100 × 109/l and “good responders” to prephase. Medac E. coli asparaginase was associated with longer EFS [hazard ratio (HR) 0·54, P = 0·0015] and overall survival (HR 0·51, P = 0·0018). Induction therapy with dexamethasone did not improve EFS compared to prednisolone. Remarkably, intensification of central nervous system (CNS)‐directed therapy in trial 58951 resulted in fewer bone marrow relapses, while the incidence of CNS relapses remained low. In summary, we showed that adequate asparaginase therapy, intensified induction treatment and intensification of CNS‐directed chemotherapy can result in an improvement of outcome in T‐ALL patients with good prephase response and initial WBC counts <100 × 109/l, representing approximately 50% of T‐ALL patients.

Dates et versions

hal-02860652 , version 1 (08-06-2020)

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Citer

Mattias Hofmans, Stefan Suciu, Alina Ferster, Pieter van Vlierberghe, Françoise Mazingue, et al.. Results of successive EORTC-CLG 58 881 and 58 951 trials in paediatric T-cell acute lymphoblastic leukaemia (ALL). British Journal of Haematology, 2019, 186 (5), pp.741--753. ⟨10.1111/bjh.15983⟩. ⟨hal-02860652⟩
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