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Clinical Trial
. 2010 Feb;24(2):285-97.
doi: 10.1038/leu.2009.262. Epub 2009 Dec 17.

Long-term results of the children's cancer group studies for childhood acute lymphoblastic leukemia 1983-2002: a Children's Oncology Group Report

P S Gaynon  1 , A L Angiolillo, W L Carroll, J B Nachman, M E Trigg, H N Sather, S P Hunger, M Devidas; Children's Oncology Group
Affiliations
Clinical Trial

Long-term results of the children's cancer group studies for childhood acute lymphoblastic leukemia 1983-2002: a Children's Oncology Group Report

P S Gaynon et al. Leukemia. 2010 Feb.

Abstract

The Children's Cancer Group enrolled 13 298 young people age <21 years on 1 of 16 protocols between 1983 and 2002. Outcomes were examined in three time periods, 1983-1988, 1989-1995, 1996-2002. Over the three intervals, 10-year event-free survival (EFS) for Rome/National Cancer Institute standard risk (SR) and higher risk (HR) B-precursor patients was 68 and 58%, 77 and 63%, and 78 and 67%, respectively, whereas for SR and HR T-cell patients, EFS was 65 and 56%, 78 and 68%, and 70 and 72%, respectively. Five-year EFS for infants was 36, 38, and 43%, respectively. Seminal randomized studies led to a number of important findings. Stronger post-induction intensification improved outcome for both SR and HR patients. With improved systemic therapy, additional intrathecal (IT) methotrexate effectively replaced cranial radiation. For SR patients receiving three-drug induction, iso-toxic substitution of dexamethasone for prednisone improved EFS. Pegylated asparaginase safely and effectively replaced native asparaginase. Thus, rational therapy modifications yielded better outcomes for both SR and HR patients. These trials provide the platforms for current Children's Oncology Group trials.

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Figures

Figure 1
Figure 1. Event-Free Survival for B-precursor ALL by Study Series

  1. Standard risk [CCG-100 series (1983–1988), CCG-1800 series (1989–1995), and CCG-1900 series (1996–2002)]; SR, Standard risk; EFS, event-free survival

  2. Higher risk [CCG-100 series (1983–1988), CCG-1800 series (1989–1995), and CCG-1900 series (1996–2002)]; HR, high risk; EFS, event free survival

Figure 1
Figure 1. Event-Free Survival for B-precursor ALL by Study Series

  1. Standard risk [CCG-100 series (1983–1988), CCG-1800 series (1989–1995), and CCG-1900 series (1996–2002)]; SR, Standard risk; EFS, event-free survival

  2. Higher risk [CCG-100 series (1983–1988), CCG-1800 series (1989–1995), and CCG-1900 series (1996–2002)]; HR, high risk; EFS, event free survival

Figure 2
Figure 2
Event-Free Survival for T-cell ALL by Study Series [CCG-100 series (1983–1988), CCG-1800 series (1989–1995), and CCG-1900 series (1996–2002)] EFS, event-free survival
Figure 3
Figure 3
Event-Free Survival for Infant ALL by Study Series CCG-100 series (1983–1988), CCG-1800 series (1989–1995), and CCG-1900 series (1996–2002)]; EFS, event-free survival
Figure 4
Figure 4. Cumulative Incidence of Remission Death, Isolated Central Nervous System (CNS) Relapse, Any CNS Relapse, and Secondary Malignant Neoplasm (SMN)

  1. CCG-100 Series (1983–1988)

  2. CCG-1800 Series (1989–1995)

  3. CCG-1900 Series (1996–2002)

Figure 4
Figure 4. Cumulative Incidence of Remission Death, Isolated Central Nervous System (CNS) Relapse, Any CNS Relapse, and Secondary Malignant Neoplasm (SMN)

  1. CCG-100 Series (1983–1988)

  2. CCG-1800 Series (1989–1995)

  3. CCG-1900 Series (1996–2002)

Figure 4
Figure 4. Cumulative Incidence of Remission Death, Isolated Central Nervous System (CNS) Relapse, Any CNS Relapse, and Secondary Malignant Neoplasm (SMN)

  1. CCG-100 Series (1983–1988)

  2. CCG-1800 Series (1989–1995)

  3. CCG-1900 Series (1996–2002)

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