TY - JOUR
T1 - Outcome of central nervous system relapses in childhood acute lymphoblastic Leukaemia - Prospective open cohort analyses of the ALLR3 trial
AU - Masurekar, Ashish Narayan
AU - Parker, Catriona A.
AU - Shanyinde, Milensu
AU - Moorman, Anthony V.
AU - Hancock, Jeremy P.
AU - Sutton, Rosemary
AU - Ancliff, Philip J.
AU - Morgan, Mary
AU - Goulden, Nicholas J.
AU - Fraser, Chris
AU - Hoogerbrugge, Peter M.
AU - Revesz, Tamas
AU - Darbyshire, Philip J.
AU - Krishnan, Shekhar
AU - Love, Sharon B.
AU - Saha, Vaskar
N1 - Publisher Copyright:
© 2014 Masurekar et al.
PY - 2014/10/3
Y1 - 2014/10/3
N2 - The outcomes of Central Nervous System (CNS) relapses in children with acute lymphoblastic leukaemia (ALL) treated in the ALL R3 trial, between January 2003 and March 2011 were analysed. Patients were risk stratified, to receive a matched donor allogeneic transplant or fractionated cranial irradiation with continued treatment for two years. A randomisation of Idarubicin with Mitoxantrone closed in December 2007 in favour of Mitoxantrone. The estimated 3-year progression free survival for combined and isolated CNS disease were 40.6% (25·1, 55·6) and 38.0% (26.2, 49.7) respectively. Univariate analysis showed a significantly better survival for age <10 years, progenitor-B cell disease, good-risk cytogenetics and those receiving Mitoxantrone. Adjusting for these variables (age, time to relapse, cytogenetics, treatment drug and gender) a multivariate analysis, showed a poorer outcome for those with combined CNS relapse (HR 2·64, 95% CI 1·32, 5·31, p=0·006 for OS). ALL R3 showed an improvement in outcome for CNS relapses treated with Mitoxantrone compared to Idarubicin; a potential benefit for matched donor transplant for those with very early and early isolated-CNS relapses.
AB - The outcomes of Central Nervous System (CNS) relapses in children with acute lymphoblastic leukaemia (ALL) treated in the ALL R3 trial, between January 2003 and March 2011 were analysed. Patients were risk stratified, to receive a matched donor allogeneic transplant or fractionated cranial irradiation with continued treatment for two years. A randomisation of Idarubicin with Mitoxantrone closed in December 2007 in favour of Mitoxantrone. The estimated 3-year progression free survival for combined and isolated CNS disease were 40.6% (25·1, 55·6) and 38.0% (26.2, 49.7) respectively. Univariate analysis showed a significantly better survival for age <10 years, progenitor-B cell disease, good-risk cytogenetics and those receiving Mitoxantrone. Adjusting for these variables (age, time to relapse, cytogenetics, treatment drug and gender) a multivariate analysis, showed a poorer outcome for those with combined CNS relapse (HR 2·64, 95% CI 1·32, 5·31, p=0·006 for OS). ALL R3 showed an improvement in outcome for CNS relapses treated with Mitoxantrone compared to Idarubicin; a potential benefit for matched donor transplant for those with very early and early isolated-CNS relapses.
UR - http://www.scopus.com/inward/record.url?scp=84908636930&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0108107
DO - 10.1371/journal.pone.0108107
M3 - Review article
C2 - 25279465
AN - SCOPUS:84908636930
SN - 1932-6203
VL - 9
JO - PLoS ONE
JF - PLoS ONE
IS - 10
M1 - e108107
ER -