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We report on the outcome of children with Philadelphia positive acute lymphoblastic leukaemia (Ph+ ALL) treated on the UK Medical Research Council (MRC) trial for childhood ALL, MRC ALL 97, between January 1997 and June 2002. Forty-two (2.3%) patients were Ph+. Nineteen (45%) had <25% blasts in bone marrow (BM) within the first 2 weeks of treatment and were defined as a good response group (GRG), the others as a poor response group (PRG). Thirty-six (86%) achieved first complete remission (CR1) at the end of induction, of which 28 underwent BM transplantation (BMT). The median follow-up was 42 months (range, 21-84). The 3-year event-free survival (EFS; 52%, 95% CI, 36-66%) was a considerable improvement on the previous MRC UKALL XI trial (27%). EFS for the GRG and PRG were 68% (43-84%) and 39% (18-59%), respectively (P = 0.03); presenting white cell count <50 x 10(9)/l (P = 0.02) was predictive for overall survival. Changes in the MRC ALL97 trial within the study period resulted in some Ph+ ALL receiving daunorubicin and either prednisolone or dexamethasone during induction. Though the use of daunorubicin during induction was not a prospective study question, EFS was significantly better for those whose induction included this drug (P = 0.02). Steroid randomization was not stratified for Ph+ ALL patients and was not predictive for EFS. BMT in CR1 appeared to reduce the risk of a subsequent BM relapse. These results show significant improvement on previous MRC trials; future therapeutic strategies should include early intensive therapy and BMT in CR1.

Original publication

DOI

10.1111/j.1365-2141.2005.05425.x

Type

Journal article

Journal

British journal of haematology

Publication Date

04/2005

Volume

129

Pages

35 - 44

Addresses

Cancer Research UK Children's Cancer Group, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Keywords

Medical Research Council Childhood Leukaemia Working Party, Philadelphia Chromosome, Humans, Daunorubicin, Dexamethasone, Prednisolone, Antineoplastic Combined Chemotherapy Protocols, Leukocyte Count, Prognosis, Treatment Outcome, Combined Modality Therapy, Bone Marrow Transplantation, Survival Analysis, Adolescent, Child, Child, Preschool, Infant, Female, Male, Precursor Cell Lymphoblastic Leukemia-Lymphoma