Outcome of reinduction chemotherapy with a modified dose of idarubicin for children with marrow-relapsed acute lymphoblastic leukemia: Results of the childhood acute lymphoblastic leukemia (CALL)-0603 study

Kyung Nam Koh, Ho Joon Im, Hyery Kim, Hyoung Jin Kang, Kyung Duk Park, Hee Young Shin, Hyo Seop Ahn, Ji Won Lee, Keon Hee Yoo, Ki Woong Sung, Hong Hoe Koo, Young Tak Lim, Jun Eun Park, Byung Kiu Park, Hyeon Jin Park, Jong Jin Seo

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

This multicenter, prospective trial was conducted to develop an effective and safe reinduction regimen for marrow-relapsed pediatric acute lymphoblastic leukemia (ALL) by modifying the dose of idarubicin. Between 2006 and 2009, the trial accrued 44 patients, 1 to 21 years old with first marrow-relapsed ALL. The reinduction regimen comprised prednisolone, vincristine, L-asparaginase, and idarubicin (10 mg/m2/week). The idarubicin dose was adjusted according to the degree of myelosuppression. The second complete remission (CR2) rate was 72.7%, obtained by 54.2% of patients with early relapse < 24 months after initial diagnosis and 95.0% of those with late relapse (P = 0.002). Five patients entered remission with extended treatment, resulting in a final CR2 rate of 84.1%. The CR2 rate was not significantly different according to the idarubicin dose. The induction death rate was 2.3% (1/44). The 5-year event-free and overall survival rates were 22.2% ± 6.4% and 27.3% ± 6.7% for all patients, 4.2% ± 4.1% and 8.3% ± 5.6% for early relapsers, and 43.8% ± 11.4% and 50.0% ± 11.2% for late relapsers, respectively. Early relapse and slow response to reinduction chemotherapy were predictors of poor outcomes. In conclusion, a modified dose of idarubicin was effectively incorporated into the reinduction regimen for late marrow-relapsed ALL with a low toxic death rate. However, the CR2 rate for early relapsers was suboptimal, and the second remission was not durable in most patients.

Original languageEnglish
Pages (from-to)642-649
Number of pages8
JournalJournal of Korean Medical Science
Volume32
Issue number4
DOIs
StatePublished - 1 Jan 2017

Fingerprint

Idarubicin
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Bone Marrow
Drug Therapy
Recurrence
Asparaginase
Mortality
Poisons
Vincristine
Prednisolone
Multicenter Studies
Disease-Free Survival
Survival Rate
Pediatrics

Keywords

  • Acute lymphoblastic leukemia
  • Childhood
  • Idarubicin
  • Induction
  • Relapse

Cite this

Koh, Kyung Nam ; Im, Ho Joon ; Kim, Hyery ; Kang, Hyoung Jin ; Park, Kyung Duk ; Shin, Hee Young ; Ahn, Hyo Seop ; Lee, Ji Won ; Yoo, Keon Hee ; Sung, Ki Woong ; Koo, Hong Hoe ; Lim, Young Tak ; Park, Jun Eun ; Park, Byung Kiu ; Park, Hyeon Jin ; Seo, Jong Jin. / Outcome of reinduction chemotherapy with a modified dose of idarubicin for children with marrow-relapsed acute lymphoblastic leukemia : Results of the childhood acute lymphoblastic leukemia (CALL)-0603 study. In: Journal of Korean Medical Science. 2017 ; Vol. 32, No. 4. pp. 642-649.
@article{e90ef5aa020946e2be886e981ee5d384,
title = "Outcome of reinduction chemotherapy with a modified dose of idarubicin for children with marrow-relapsed acute lymphoblastic leukemia: Results of the childhood acute lymphoblastic leukemia (CALL)-0603 study",
abstract = "This multicenter, prospective trial was conducted to develop an effective and safe reinduction regimen for marrow-relapsed pediatric acute lymphoblastic leukemia (ALL) by modifying the dose of idarubicin. Between 2006 and 2009, the trial accrued 44 patients, 1 to 21 years old with first marrow-relapsed ALL. The reinduction regimen comprised prednisolone, vincristine, L-asparaginase, and idarubicin (10 mg/m2/week). The idarubicin dose was adjusted according to the degree of myelosuppression. The second complete remission (CR2) rate was 72.7{\%}, obtained by 54.2{\%} of patients with early relapse < 24 months after initial diagnosis and 95.0{\%} of those with late relapse (P = 0.002). Five patients entered remission with extended treatment, resulting in a final CR2 rate of 84.1{\%}. The CR2 rate was not significantly different according to the idarubicin dose. The induction death rate was 2.3{\%} (1/44). The 5-year event-free and overall survival rates were 22.2{\%} ± 6.4{\%} and 27.3{\%} ± 6.7{\%} for all patients, 4.2{\%} ± 4.1{\%} and 8.3{\%} ± 5.6{\%} for early relapsers, and 43.8{\%} ± 11.4{\%} and 50.0{\%} ± 11.2{\%} for late relapsers, respectively. Early relapse and slow response to reinduction chemotherapy were predictors of poor outcomes. In conclusion, a modified dose of idarubicin was effectively incorporated into the reinduction regimen for late marrow-relapsed ALL with a low toxic death rate. However, the CR2 rate for early relapsers was suboptimal, and the second remission was not durable in most patients.",
keywords = "Acute lymphoblastic leukemia, Childhood, Idarubicin, Induction, Relapse",
author = "Koh, {Kyung Nam} and Im, {Ho Joon} and Hyery Kim and Kang, {Hyoung Jin} and Park, {Kyung Duk} and Shin, {Hee Young} and Ahn, {Hyo Seop} and Lee, {Ji Won} and Yoo, {Keon Hee} and Sung, {Ki Woong} and Koo, {Hong Hoe} and Lim, {Young Tak} and Park, {Jun Eun} and Park, {Byung Kiu} and Park, {Hyeon Jin} and Seo, {Jong Jin}",
year = "2017",
month = "1",
day = "1",
doi = "10.3346/jkms.2017.32.4.642",
language = "English",
volume = "32",
pages = "642--649",
journal = "Journal of Korean medical science",
issn = "1011-8934",
publisher = "Korean Academy of Medical Science",
number = "4",

}

Outcome of reinduction chemotherapy with a modified dose of idarubicin for children with marrow-relapsed acute lymphoblastic leukemia : Results of the childhood acute lymphoblastic leukemia (CALL)-0603 study. / Koh, Kyung Nam; Im, Ho Joon; Kim, Hyery; Kang, Hyoung Jin; Park, Kyung Duk; Shin, Hee Young; Ahn, Hyo Seop; Lee, Ji Won; Yoo, Keon Hee; Sung, Ki Woong; Koo, Hong Hoe; Lim, Young Tak; Park, Jun Eun; Park, Byung Kiu; Park, Hyeon Jin; Seo, Jong Jin.

In: Journal of Korean Medical Science, Vol. 32, No. 4, 01.01.2017, p. 642-649.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcome of reinduction chemotherapy with a modified dose of idarubicin for children with marrow-relapsed acute lymphoblastic leukemia

T2 - Results of the childhood acute lymphoblastic leukemia (CALL)-0603 study

AU - Koh, Kyung Nam

AU - Im, Ho Joon

AU - Kim, Hyery

AU - Kang, Hyoung Jin

AU - Park, Kyung Duk

AU - Shin, Hee Young

AU - Ahn, Hyo Seop

AU - Lee, Ji Won

AU - Yoo, Keon Hee

AU - Sung, Ki Woong

AU - Koo, Hong Hoe

AU - Lim, Young Tak

AU - Park, Jun Eun

AU - Park, Byung Kiu

AU - Park, Hyeon Jin

AU - Seo, Jong Jin

PY - 2017/1/1

Y1 - 2017/1/1

N2 - This multicenter, prospective trial was conducted to develop an effective and safe reinduction regimen for marrow-relapsed pediatric acute lymphoblastic leukemia (ALL) by modifying the dose of idarubicin. Between 2006 and 2009, the trial accrued 44 patients, 1 to 21 years old with first marrow-relapsed ALL. The reinduction regimen comprised prednisolone, vincristine, L-asparaginase, and idarubicin (10 mg/m2/week). The idarubicin dose was adjusted according to the degree of myelosuppression. The second complete remission (CR2) rate was 72.7%, obtained by 54.2% of patients with early relapse < 24 months after initial diagnosis and 95.0% of those with late relapse (P = 0.002). Five patients entered remission with extended treatment, resulting in a final CR2 rate of 84.1%. The CR2 rate was not significantly different according to the idarubicin dose. The induction death rate was 2.3% (1/44). The 5-year event-free and overall survival rates were 22.2% ± 6.4% and 27.3% ± 6.7% for all patients, 4.2% ± 4.1% and 8.3% ± 5.6% for early relapsers, and 43.8% ± 11.4% and 50.0% ± 11.2% for late relapsers, respectively. Early relapse and slow response to reinduction chemotherapy were predictors of poor outcomes. In conclusion, a modified dose of idarubicin was effectively incorporated into the reinduction regimen for late marrow-relapsed ALL with a low toxic death rate. However, the CR2 rate for early relapsers was suboptimal, and the second remission was not durable in most patients.

AB - This multicenter, prospective trial was conducted to develop an effective and safe reinduction regimen for marrow-relapsed pediatric acute lymphoblastic leukemia (ALL) by modifying the dose of idarubicin. Between 2006 and 2009, the trial accrued 44 patients, 1 to 21 years old with first marrow-relapsed ALL. The reinduction regimen comprised prednisolone, vincristine, L-asparaginase, and idarubicin (10 mg/m2/week). The idarubicin dose was adjusted according to the degree of myelosuppression. The second complete remission (CR2) rate was 72.7%, obtained by 54.2% of patients with early relapse < 24 months after initial diagnosis and 95.0% of those with late relapse (P = 0.002). Five patients entered remission with extended treatment, resulting in a final CR2 rate of 84.1%. The CR2 rate was not significantly different according to the idarubicin dose. The induction death rate was 2.3% (1/44). The 5-year event-free and overall survival rates were 22.2% ± 6.4% and 27.3% ± 6.7% for all patients, 4.2% ± 4.1% and 8.3% ± 5.6% for early relapsers, and 43.8% ± 11.4% and 50.0% ± 11.2% for late relapsers, respectively. Early relapse and slow response to reinduction chemotherapy were predictors of poor outcomes. In conclusion, a modified dose of idarubicin was effectively incorporated into the reinduction regimen for late marrow-relapsed ALL with a low toxic death rate. However, the CR2 rate for early relapsers was suboptimal, and the second remission was not durable in most patients.

KW - Acute lymphoblastic leukemia

KW - Childhood

KW - Idarubicin

KW - Induction

KW - Relapse

UR - http://www.scopus.com/inward/record.url?scp=85015165726&partnerID=8YFLogxK

U2 - 10.3346/jkms.2017.32.4.642

DO - 10.3346/jkms.2017.32.4.642

M3 - Article

C2 - 28244291

AN - SCOPUS:85015165726

VL - 32

SP - 642

EP - 649

JO - Journal of Korean medical science

JF - Journal of Korean medical science

SN - 1011-8934

IS - 4

ER -