Treatment of Childhood Acute Lymphoblastic Leukemia with B-Cell Precursor Phenotype Arata WATANABE Department of Pediatrics, Nakadori General Hospital
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1 Treatment of Childhood Acute Lymphoblastic Leukemia with B-Cell Precursor Phenotype Arata WATANABE Department of Pediatrics, Nakadori General Hospital Abstract Although more than 80% of children with acute lymphoblastic leukemia of the B-cell precursor phenotype (BCP-ALL) has been cured by the 4 groups' clinical study in Japan, the remaining 20% of patients underwent some events including induction failure, relapse, secondary cancer and also suffered from late complication. Japanese Pediatric Leukemia/ Lymphoma Study Group (JPLSG) was organized in 2003 and the JPLSG protocols have been already started for three distinct and rare types of ALL, including mature B-ALL, infant ALL and Ph+ALL. We are just planning to start JPLSG T-cell ALL protocol in For the purpose of finding the standard treatment of BCR-ALL in Japan, central nervous system leukemia directed treatment is important to avoid pre-symptomatic cranial radiotherapy. Then, for the best cure by the best treatment, it is importanr that risk-directed stratification also contain not only age and WBC count at onset, but also genetic subtype of BCP-ALL, early response to treatment and introduction of selected antileukemic drugs being tested in clinical trials. Key words: acute lymphoblastic leukemia, B-cell precursor phenotype, central nervous system leukemia, minimal residual disease, clofarabine Reprint requests to Arata Watanabe, Department of Pediatrics, Nakadori General Hospital, 3-15, Misono-cho, Minamidori, Akita, Japan
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3 Fig. 1 Two step stratification based on age/wbc and time point 2 (day: 84) MRD (CCLSG ALL 2004 protocol)
4 Table 1 Clinical and biological features of the more common genetic subtypes of childhood B lineage ALL')
5 Table 3 Current use of prophylactic cranial irradiation in childhood ALL in selected study group25)
6 Fig. 2 Event-free survival (EFS) estimates of patients treated on ALinC 16 and their relation to TEL gene status (A) EFS estimates of patients with TEL rearrangements (R-TEL) compared with those of patients with germline TEL (G-TEL). (B) EFS estimates of patients with National Cancer Institute (NCI) standrad-risk ALL shown in relation to TEL status. (C) EFS estimates of patients with NCI high-risk ALL shown in relation to TEL status.31)
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Lancet Oncol 9: 1-12, ) Vilmer E, Suciu S, Ferster A, et al: Long-term results of three randomized trials (58831, 58832, 58881) in childhood acute lymphoblastic leukemia: A CLCG-EORTC report. Leukemia 14: , ) Perel Y, Leverger G, Carrere A, et al: Second thyroid neplasms after prophylactic cranial irradiation for acute lymphoblastic leukemia. Am J Hematol 59: 91-94, ) Tucker MA, Morris Jones PH, Boice JD Jr, et al: Therapeutic radiation at a young age is linked to secondary thyroid cancer. Cancer Res 51: , ) Rocha JCC, Cheng C, Liu W, et al: Pharmacogenetics of outcome in children with acute lymphoblastic leukemia. Blood 105: , ) Cario G, Izraeli S, Teichert A, et al: High interleukin-15 expression characterized childhood acute lymphoblastic leukemia with involvement of the CNS. J Clin Oncol 25: , ) van Dongen JJ, Seriu T, Panzer-Grumayer, et al: Prognostic value of minimal residual disease in acute lymphoblastic leukemia in childhood. 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