Modifications to induction therapy decrease risk of early death in infants with acute lymphoblastic leukemia treated on Children's Oncology Group P9407

Wanda L. Salzer, Tamekia Jones, Meenakshi Devidas, Joanne M. Hilden, Naomi Winick, Stephen Hunger, William L. Carroll, Bruce Camitta, Zoann E. Dreyer

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Infants (<366 days of age) with acute lymphoblastic leukemia (ALL) have a poor prognosis. Most treatment failures occur within 6-9 months of diagnosis, primarily from relapse. Procedure: The Children's Oncology Group P9407 study was designed to test if early intensified treatment would improve outcome for infants with ALL. Due to a significant number of early deaths (<90 days from enrollment), Induction therapy was amended three times. Cohorts 1+2 (n=68), received identical Induction therapy except for reduced daunorubicin dose in Cohort 2. Cohort 3 (n=141) received prednisone (40mg/m2/day) instead of dexamethasone (10mg/m2/day) and short infusion daunorubicin (30 minutes) instead of continuous infusion (48 hours), as well as additional supportive care measures throughout therapy. Results: Early deaths occurred in 17/68 (25%) infants in Cohorts 1+2 and 8/141 (5.7%) infants in Cohort 3 (P<0.0001). Among infants ≤90 days of age at diagnosis, early death occurred in 10/17 (58.8%) in Cohorts 1+2 and 4/27 (14.8%) in Cohort 3 (P=0.006). Among infants >90 days of age at diagnosis, early death occurred in 7/51 (13.7%) in Cohorts 1+2 and 4/114 (3.5%) in Cohort 3 (P=0.036). Bacterial, viral, and fungal infections were more common in Cohorts 1+2 versus Cohort 3. Conclusions: Early morbidity and mortality for infants with ALL were reduced by substitution of prednisone (40mg/m2/day) for dexamethasone (10mg/m2/day), the delivery of daunorubicin over 30 minutes instead of a continuous infusion for 48 hours, and the provision of more specific supportive care measures.

Original languageEnglish (US)
Pages (from-to)834-839
Number of pages6
JournalPediatric Blood and Cancer
Volume59
Issue number5
DOIs
StatePublished - Nov 1 2012
Externally publishedYes

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Daunorubicin
Mycoses
Infant Mortality
Virus Diseases
Prednisone
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Bacterial Infections
Dexamethasone
Morbidity
Therapeutics
Infant Death

All Science Journal Classification (ASJC) codes

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

Modifications to induction therapy decrease risk of early death in infants with acute lymphoblastic leukemia treated on Children's Oncology Group P9407. / Salzer, Wanda L.; Jones, Tamekia; Devidas, Meenakshi; Hilden, Joanne M.; Winick, Naomi; Hunger, Stephen; Carroll, William L.; Camitta, Bruce; Dreyer, Zoann E.

In: Pediatric Blood and Cancer, Vol. 59, No. 5, 01.11.2012, p. 834-839.

Research output: Contribution to journalArticle

Salzer, Wanda L. ; Jones, Tamekia ; Devidas, Meenakshi ; Hilden, Joanne M. ; Winick, Naomi ; Hunger, Stephen ; Carroll, William L. ; Camitta, Bruce ; Dreyer, Zoann E. / Modifications to induction therapy decrease risk of early death in infants with acute lymphoblastic leukemia treated on Children's Oncology Group P9407. In: Pediatric Blood and Cancer. 2012 ; Vol. 59, No. 5. pp. 834-839.
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abstract = "Background: Infants (<366 days of age) with acute lymphoblastic leukemia (ALL) have a poor prognosis. Most treatment failures occur within 6-9 months of diagnosis, primarily from relapse. Procedure: The Children's Oncology Group P9407 study was designed to test if early intensified treatment would improve outcome for infants with ALL. Due to a significant number of early deaths (<90 days from enrollment), Induction therapy was amended three times. Cohorts 1+2 (n=68), received identical Induction therapy except for reduced daunorubicin dose in Cohort 2. Cohort 3 (n=141) received prednisone (40mg/m2/day) instead of dexamethasone (10mg/m2/day) and short infusion daunorubicin (30 minutes) instead of continuous infusion (48 hours), as well as additional supportive care measures throughout therapy. Results: Early deaths occurred in 17/68 (25{\%}) infants in Cohorts 1+2 and 8/141 (5.7{\%}) infants in Cohort 3 (P<0.0001). Among infants ≤90 days of age at diagnosis, early death occurred in 10/17 (58.8{\%}) in Cohorts 1+2 and 4/27 (14.8{\%}) in Cohort 3 (P=0.006). Among infants >90 days of age at diagnosis, early death occurred in 7/51 (13.7{\%}) in Cohorts 1+2 and 4/114 (3.5{\%}) in Cohort 3 (P=0.036). Bacterial, viral, and fungal infections were more common in Cohorts 1+2 versus Cohort 3. Conclusions: Early morbidity and mortality for infants with ALL were reduced by substitution of prednisone (40mg/m2/day) for dexamethasone (10mg/m2/day), the delivery of daunorubicin over 30 minutes instead of a continuous infusion for 48 hours, and the provision of more specific supportive care measures.",
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T1 - Modifications to induction therapy decrease risk of early death in infants with acute lymphoblastic leukemia treated on Children's Oncology Group P9407

AU - Salzer, Wanda L.

AU - Jones, Tamekia

AU - Devidas, Meenakshi

AU - Hilden, Joanne M.

AU - Winick, Naomi

AU - Hunger, Stephen

AU - Carroll, William L.

AU - Camitta, Bruce

AU - Dreyer, Zoann E.

PY - 2012/11/1

Y1 - 2012/11/1

N2 - Background: Infants (<366 days of age) with acute lymphoblastic leukemia (ALL) have a poor prognosis. Most treatment failures occur within 6-9 months of diagnosis, primarily from relapse. Procedure: The Children's Oncology Group P9407 study was designed to test if early intensified treatment would improve outcome for infants with ALL. Due to a significant number of early deaths (<90 days from enrollment), Induction therapy was amended three times. Cohorts 1+2 (n=68), received identical Induction therapy except for reduced daunorubicin dose in Cohort 2. Cohort 3 (n=141) received prednisone (40mg/m2/day) instead of dexamethasone (10mg/m2/day) and short infusion daunorubicin (30 minutes) instead of continuous infusion (48 hours), as well as additional supportive care measures throughout therapy. Results: Early deaths occurred in 17/68 (25%) infants in Cohorts 1+2 and 8/141 (5.7%) infants in Cohort 3 (P<0.0001). Among infants ≤90 days of age at diagnosis, early death occurred in 10/17 (58.8%) in Cohorts 1+2 and 4/27 (14.8%) in Cohort 3 (P=0.006). Among infants >90 days of age at diagnosis, early death occurred in 7/51 (13.7%) in Cohorts 1+2 and 4/114 (3.5%) in Cohort 3 (P=0.036). Bacterial, viral, and fungal infections were more common in Cohorts 1+2 versus Cohort 3. Conclusions: Early morbidity and mortality for infants with ALL were reduced by substitution of prednisone (40mg/m2/day) for dexamethasone (10mg/m2/day), the delivery of daunorubicin over 30 minutes instead of a continuous infusion for 48 hours, and the provision of more specific supportive care measures.

AB - Background: Infants (<366 days of age) with acute lymphoblastic leukemia (ALL) have a poor prognosis. Most treatment failures occur within 6-9 months of diagnosis, primarily from relapse. Procedure: The Children's Oncology Group P9407 study was designed to test if early intensified treatment would improve outcome for infants with ALL. Due to a significant number of early deaths (<90 days from enrollment), Induction therapy was amended three times. Cohorts 1+2 (n=68), received identical Induction therapy except for reduced daunorubicin dose in Cohort 2. Cohort 3 (n=141) received prednisone (40mg/m2/day) instead of dexamethasone (10mg/m2/day) and short infusion daunorubicin (30 minutes) instead of continuous infusion (48 hours), as well as additional supportive care measures throughout therapy. Results: Early deaths occurred in 17/68 (25%) infants in Cohorts 1+2 and 8/141 (5.7%) infants in Cohort 3 (P<0.0001). Among infants ≤90 days of age at diagnosis, early death occurred in 10/17 (58.8%) in Cohorts 1+2 and 4/27 (14.8%) in Cohort 3 (P=0.006). Among infants >90 days of age at diagnosis, early death occurred in 7/51 (13.7%) in Cohorts 1+2 and 4/114 (3.5%) in Cohort 3 (P=0.036). Bacterial, viral, and fungal infections were more common in Cohorts 1+2 versus Cohort 3. Conclusions: Early morbidity and mortality for infants with ALL were reduced by substitution of prednisone (40mg/m2/day) for dexamethasone (10mg/m2/day), the delivery of daunorubicin over 30 minutes instead of a continuous infusion for 48 hours, and the provision of more specific supportive care measures.

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