1989 Volume 30 Issue 7 Pages 967-974
From 1984 to 1987, 144 previously untreated children with low (LR) or intermediate-risk (IR) acute lymphoblastic leukemia (ALL) were entered in the protocol L 841 or I 841, respectively. The patients in the LR group were randomized to receive regimen A (L 841 A) or B (L 841 B) and the patients in the IR group were randomized to receive regimen B (I 841 B) or C (I 841 C). L 841 A consisted of vincristine (VCR)+prednisone (PDN) for the remission induction phase and 18 Gy cranial irradiation combined with intrathecal methotrexate (MTX) for the central nervous system (CNS) leukemia prophylaxis. The maintenance phase consisted of MTX iv alternating 5-day course of VCR+PDN+6-mercaptopurine (6MP) at 2 wk-interval. In L 841 B, I 841 B and I 841 C, asparaginase (ASP) was added as a third drug. Adriamycin (ADM) and high-dose MTX (100 mg/kg) were additionally employed in the intensive phase of I 841 C. Thirty-nine, 20, 25 and 49 eligible patients were entered in L 841 A, L 841 B, I 841 B and I 841 C, respectively. The event free survival rate in each regimen was 50.5%±13.7% (M±SE), 100%±6.0% (p<0.01), 72.7%±9.8% and 40.7%±13.2% (p<0.1) at 4 years, respectively. These data suggested that the three drug combination in the remission induction phase was much more effective than the two drug combination regimen in LR ALL. Further studies will be needed to improve the EFS rate of the patients with IR ALL.
