A revised definition for cure of childhood acute lymphoblastic leukemia

C. H. Pui, D. Pei, D. Campana, C. Cheng, J. T. Sandlund, W. P. Bowman, M. M. Hudson, R. C. Ribeiro, S. C. Raimondi, S. Jeha, Scott Howard, D. Bhojwani, H. Inaba, J. E. Rubnitz, M. L. Metzger, T. A. Gruber, E. Coustan-Smith, J. R. Downing, W. H. Leung, M. V. Relling & 1 others W. E. Evans

Research output: Contribution to journalArticle

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Abstract

With improved contemporary therapy, we reassess long-term outcome in patients completing treatment for childhood acute lymphoblastic leukemia (ALL) to determine when cure can be declared with a high degree of confidence. In six successive clinical trials between 1984 and 2007, 1291 (84.5%) patients completed all therapies in continuous complete remission. The post-therapy cumulative risk of relapse or development of a second neoplasm and the event-free survival rate and overall survival were analyzed according to the presenting features and the three treatment periods defined by relative outcome. Over the three treatment periods, there has been progressive increase in the rate of event-free survival (65.2% vs 74.8% vs 85.1% (P<0.001)) and overall survival (76.5% vs 81.1% vs 91.7% (P<0.001)) at 10 years. The most important predictor of outcome after completion of therapy was the type of treatment. In the most recent treatment period, which omitted the use of prophylactic cranial irradiation, the post-treatment cumulative risk of relapse was 6.4%, death in remission 1.5% and development of a second neoplasm 2.3% at 10 years, with all relapses except one occurring within 4 years of therapy. None of the 106 patients with the t(9;22)/BCR-ABL1, t(1;19)/TCF3-PBX1 or t(4;11)/MLL-AFF1 had relapsed after 2 years from completion of therapy. These findings demonstrate that with contemporary effective therapy that excludes cranial irradiation, approximately 6% of children with ALL may relapse after completion of treatment, and those who remain in remission at 4 years post treatment may be considered cured (that is, less than 1% chance of relapse).

Original languageEnglish (US)
Pages (from-to)2336-2343
Number of pages8
JournalLeukemia
Volume28
Issue number12
DOIs
StatePublished - Dec 11 2014

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Therapeutics
Recurrence
Cranial Irradiation
Second Primary Neoplasms
Disease-Free Survival
Survival
Survival Rate

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Pui, C. H., Pei, D., Campana, D., Cheng, C., Sandlund, J. T., Bowman, W. P., ... Evans, W. E. (2014). A revised definition for cure of childhood acute lymphoblastic leukemia. Leukemia, 28(12), 2336-2343. https://doi.org/10.1038/leu.2014.142

A revised definition for cure of childhood acute lymphoblastic leukemia. / Pui, C. H.; Pei, D.; Campana, D.; Cheng, C.; Sandlund, J. T.; Bowman, W. P.; Hudson, M. M.; Ribeiro, R. C.; Raimondi, S. C.; Jeha, S.; Howard, Scott; Bhojwani, D.; Inaba, H.; Rubnitz, J. E.; Metzger, M. L.; Gruber, T. A.; Coustan-Smith, E.; Downing, J. R.; Leung, W. H.; Relling, M. V.; Evans, W. E.

In: Leukemia, Vol. 28, No. 12, 11.12.2014, p. 2336-2343.

Research output: Contribution to journalArticle

Pui, CH, Pei, D, Campana, D, Cheng, C, Sandlund, JT, Bowman, WP, Hudson, MM, Ribeiro, RC, Raimondi, SC, Jeha, S, Howard, S, Bhojwani, D, Inaba, H, Rubnitz, JE, Metzger, ML, Gruber, TA, Coustan-Smith, E, Downing, JR, Leung, WH, Relling, MV & Evans, WE 2014, 'A revised definition for cure of childhood acute lymphoblastic leukemia', Leukemia, vol. 28, no. 12, pp. 2336-2343. https://doi.org/10.1038/leu.2014.142
Pui CH, Pei D, Campana D, Cheng C, Sandlund JT, Bowman WP et al. A revised definition for cure of childhood acute lymphoblastic leukemia. Leukemia. 2014 Dec 11;28(12):2336-2343. https://doi.org/10.1038/leu.2014.142
Pui, C. H. ; Pei, D. ; Campana, D. ; Cheng, C. ; Sandlund, J. T. ; Bowman, W. P. ; Hudson, M. M. ; Ribeiro, R. C. ; Raimondi, S. C. ; Jeha, S. ; Howard, Scott ; Bhojwani, D. ; Inaba, H. ; Rubnitz, J. E. ; Metzger, M. L. ; Gruber, T. A. ; Coustan-Smith, E. ; Downing, J. R. ; Leung, W. H. ; Relling, M. V. ; Evans, W. E. / A revised definition for cure of childhood acute lymphoblastic leukemia. In: Leukemia. 2014 ; Vol. 28, No. 12. pp. 2336-2343.
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