Intrathecal chemotherapy earlier in the treatment for patients with acute lymphoblastic leukaemia (ALL) helps to reduce the rate of relapse, US researchers have reported.
Researchers from St Jude Children’s Research Hospital in Memphis, USA, found that the earlier addition improved central nervous system (CNS) control without adding toxicity for high-risk patients.
The results from the St Jude Total Therapy Study 16 are published in the Journal of Clinical Oncology.
The study, Total 16, studied interventions aimed at preventing relapse by improving systemic and CNS disease control. The study involved 598 patients age 18 and younger diagnosed from 2007 to 2017. The cohort included all subtypes of ALL, including B-ALL and T-ALL, those with Philadelphia chromosome rearrangements, and infant leukaemia.
A separate earlier trial, Total 15, found that the rate of CNS relapse for high-risk patients was 5.7%, while this new study found the rate of CNS relapse for a similar group of patients was reduced to 1.8%.
The earlier study had suggested that prophylactic cranial radiation was not needed – and this was supported in the latest study, the researchers say.
Total 16 also investigated in a randomised trial whether increasing the dose of PEG-asparaginase during continuation therapy improved outcomes, including reducing the risk of CNS relapse. However, the results showed that increasing the dose from 2,500 U/m2 to 3,500 U/m2 had no effect on the complete remission rate or CNS relapse rate.
The next St Jude clinical trial for ALL, Total 17, is introducing novel molecular targeted and immunotherapies, including CAR-T cells, the hospital says.
Researcher Dr Sima Jeha said: “In addition to relapse, infections and other treatment complications are the things that keep physicians up at night. Our work will continue until the day when every patient can thrive after treatment.”
Jeha, S., Pei, D., Choi, J., Cheng, C., Sandlund, J.T., Coustan-Smith, E., Campana, D., Inaba, H., Rubnitz, J.E., Ribeiro, R.C., Gruber, T.A., Raimondi, S.C., Khan, R.B., Yang, J.J., Mullighan, C.G., Downing, J.R., Evans, W.E., Relling, M.V., Pui, C.H. (2019) “Improved CNS Control of Childhood Acute Lymphoblastic Leukemia Without Cranial Irradiation: St Jude Total Therapy Study 16.” Journal of Clinical Oncology, doi: 10.1200/JCO.19.01692
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