Optimizing therapy in the modern age: differences in length of maintenance therapy in acute lymphoblastic leukemia
A majority of children and young adults with acute lymphoblastic leukemia (ALL) are cured with contemporary multiagent chemotherapy regimens. The high rate of survival is largely the result of 70 years of randomized clinical trials performed by international cooperative groups. Contemporary ALL ther...
Uložené v:
| Vydané v: | Blood Ročník 137; číslo 2; s. 168 |
|---|---|
| Hlavní autori: | , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
United States
14.01.2021
|
| Predmet: | |
| ISSN: | 1528-0020, 1528-0020 |
| On-line prístup: | Zistit podrobnosti o prístupe |
| Tagy: |
Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
|
| Abstract | A majority of children and young adults with acute lymphoblastic leukemia (ALL) are cured with contemporary multiagent chemotherapy regimens. The high rate of survival is largely the result of 70 years of randomized clinical trials performed by international cooperative groups. Contemporary ALL therapy usually consists of cycles of multiagent chemotherapy administered over 2 to 3 years that includes central nervous system (CNS) prophylaxis, primarily consisting of CNS-penetrating systemic agents and intrathecal therapy. Although the treatment backbones vary among cooperative groups, the same agents are used, and the outcomes are comparable. ALL therapy typically begins with 5 to 9 months of more-intensive chemotherapy followed by a prolonged low-intensity maintenance phase. Historically, a few cooperative groups treated boys with 1 more year of maintenance therapy than girls; however, most groups treated boys and girls with equal therapy lengths. This practice arose because of inferior survival in boys with older less-intensive regimens. The extra year of therapy added significant burden to patients and families and involved short- and long-term risks that were potentially life threatening and debilitating. The Children's Oncology Group recently changed its approach as part of its current generation of trials in B-cell ALL and now treats boys and girls with the same duration of therapy. We discuss the rationale behind this change, review the data and differences in practice across cooperative groups, and provide our perspective regarding the length of maintenance therapy. |
|---|---|
| AbstractList | A majority of children and young adults with acute lymphoblastic leukemia (ALL) are cured with contemporary multiagent chemotherapy regimens. The high rate of survival is largely the result of 70 years of randomized clinical trials performed by international cooperative groups. Contemporary ALL therapy usually consists of cycles of multiagent chemotherapy administered over 2 to 3 years that includes central nervous system (CNS) prophylaxis, primarily consisting of CNS-penetrating systemic agents and intrathecal therapy. Although the treatment backbones vary among cooperative groups, the same agents are used, and the outcomes are comparable. ALL therapy typically begins with 5 to 9 months of more-intensive chemotherapy followed by a prolonged low-intensity maintenance phase. Historically, a few cooperative groups treated boys with 1 more year of maintenance therapy than girls; however, most groups treated boys and girls with equal therapy lengths. This practice arose because of inferior survival in boys with older less-intensive regimens. The extra year of therapy added significant burden to patients and families and involved short- and long-term risks that were potentially life threatening and debilitating. The Children's Oncology Group recently changed its approach as part of its current generation of trials in B-cell ALL and now treats boys and girls with the same duration of therapy. We discuss the rationale behind this change, review the data and differences in practice across cooperative groups, and provide our perspective regarding the length of maintenance therapy. A majority of children and young adults with acute lymphoblastic leukemia (ALL) are cured with contemporary multiagent chemotherapy regimens. The high rate of survival is largely the result of 70 years of randomized clinical trials performed by international cooperative groups. Contemporary ALL therapy usually consists of cycles of multiagent chemotherapy administered over 2 to 3 years that includes central nervous system (CNS) prophylaxis, primarily consisting of CNS-penetrating systemic agents and intrathecal therapy. Although the treatment backbones vary among cooperative groups, the same agents are used, and the outcomes are comparable. ALL therapy typically begins with 5 to 9 months of more-intensive chemotherapy followed by a prolonged low-intensity maintenance phase. Historically, a few cooperative groups treated boys with 1 more year of maintenance therapy than girls; however, most groups treated boys and girls with equal therapy lengths. This practice arose because of inferior survival in boys with older less-intensive regimens. The extra year of therapy added significant burden to patients and families and involved short- and long-term risks that were potentially life threatening and debilitating. The Children's Oncology Group recently changed its approach as part of its current generation of trials in B-cell ALL and now treats boys and girls with the same duration of therapy. We discuss the rationale behind this change, review the data and differences in practice across cooperative groups, and provide our perspective regarding the length of maintenance therapy.A majority of children and young adults with acute lymphoblastic leukemia (ALL) are cured with contemporary multiagent chemotherapy regimens. The high rate of survival is largely the result of 70 years of randomized clinical trials performed by international cooperative groups. Contemporary ALL therapy usually consists of cycles of multiagent chemotherapy administered over 2 to 3 years that includes central nervous system (CNS) prophylaxis, primarily consisting of CNS-penetrating systemic agents and intrathecal therapy. Although the treatment backbones vary among cooperative groups, the same agents are used, and the outcomes are comparable. ALL therapy typically begins with 5 to 9 months of more-intensive chemotherapy followed by a prolonged low-intensity maintenance phase. Historically, a few cooperative groups treated boys with 1 more year of maintenance therapy than girls; however, most groups treated boys and girls with equal therapy lengths. This practice arose because of inferior survival in boys with older less-intensive regimens. The extra year of therapy added significant burden to patients and families and involved short- and long-term risks that were potentially life threatening and debilitating. The Children's Oncology Group recently changed its approach as part of its current generation of trials in B-cell ALL and now treats boys and girls with the same duration of therapy. We discuss the rationale behind this change, review the data and differences in practice across cooperative groups, and provide our perspective regarding the length of maintenance therapy. |
| Author | Hunger, Stephen P Teachey, David T Loh, Mignon L |
| Author_xml | – sequence: 1 givenname: David T surname: Teachey fullname: Teachey, David T organization: Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and – sequence: 2 givenname: Stephen P surname: Hunger fullname: Hunger, Stephen P organization: Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and – sequence: 3 givenname: Mignon L surname: Loh fullname: Loh, Mignon L organization: Department of Pediatrics, Benioff Children's Hospital, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32877503$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNULtOwzAUtRCIPmBnQh5ZUvyI64QNVbykSl1gjhz7pjXEdoidoXw9qShSp3t0z0NHZ4bOffCA0A0lC0oLdl-3IZgFI4wQIiVhZ2hKBSsyMn7OT_AEzWL8JITmnIlLNOGskFIQPkX9pkvW2R_rtzjtoFfdHlt_gNgFA73HagsP2NimgR68hnigW_DbtMOhwU5Zn8CrkTn1Kz0kwO3edbtQtyomq0fT8AXOqit00ag2wvXxztHH89P76jVbb17eVo_rTAvKU6apIqRgpQBQpa752DgX0lBVi6UqClpDo40UIE2hKW-Wgi9rYSQ30shlUwKbo7u_3K4P3wPEVDkbNbSt8hCGWLGcl6WUJctH6e1ROtQOTNX11ql-X_3vxH4BokVuxQ |
| CitedBy_id | crossref_primary_10_1002_cncr_34150 crossref_primary_10_1038_s41375_024_02277_9 crossref_primary_10_1182_blood_2023023155 crossref_primary_10_3390_ijms23158651 crossref_primary_10_7759_cureus_82685 crossref_primary_10_1016_j_ejca_2021_04_006 crossref_primary_10_1016_j_neuropharm_2021_108939 crossref_primary_10_3390_cells12030357 crossref_primary_10_1001_jamanetworkopen_2022_48803 crossref_primary_10_1038_s41390_022_02356_6 crossref_primary_10_3390_jcm10204728 crossref_primary_10_1051_bioconf_20248403024 crossref_primary_10_1111_jcmm_16981 crossref_primary_10_1182_blood_2022016975 crossref_primary_10_3390_cancers16040723 crossref_primary_10_1016_j_ejcped_2025_100222 crossref_primary_10_1136_bmjopen_2021_056216 crossref_primary_10_1016_j_neucli_2021_11_001 crossref_primary_10_1080_08880018_2022_2035027 crossref_primary_10_1055_s_0043_1774780 crossref_primary_10_1111_ejh_14273 crossref_primary_10_1542_peds_2023_061539 crossref_primary_10_1002_pbc_29713 crossref_primary_10_1007_s12098_023_04687_6 crossref_primary_10_1186_s40364_021_00320_w crossref_primary_10_1002_cncr_33609 crossref_primary_10_1038_s41598_023_27720_2 crossref_primary_10_1097_CCO_0000000000000778 crossref_primary_10_1371_journal_pone_0320790 crossref_primary_10_1002_pbc_30350 crossref_primary_10_1002_cam4_6495 crossref_primary_10_3390_cancers13102294 crossref_primary_10_3389_fphar_2023_1051305 crossref_primary_10_1002_pbc_31361 crossref_primary_10_1038_s41375_022_01591_4 crossref_primary_10_1371_journal_pone_0286544 crossref_primary_10_1055_s_0044_1790580 crossref_primary_10_1038_s43018_024_00863_5 |
| ContentType | Journal Article |
| Copyright | 2021 by The American Society of Hematology. |
| Copyright_xml | – notice: 2021 by The American Society of Hematology. |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1182/blood.2020007702 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine Chemistry Biology Anatomy & Physiology |
| EISSN | 1528-0020 |
| ExternalDocumentID | 32877503 |
| Genre | Research Support, Non-U.S. Gov't Journal Article Research Support, N.I.H., Extramural |
| GrantInformation_xml | – fundername: NCI NIH HHS grantid: U24 CA196173 – fundername: NCI NIH HHS grantid: R01 CA193776 – fundername: NCI NIH HHS grantid: R01 CA241452 – fundername: NCI NIH HHS grantid: U10 CA180899 – fundername: NIGMS NIH HHS grantid: P50 GM115279 – fundername: NCI NIH HHS grantid: U10 CA180886 |
| GroupedDBID | --- -~X .55 0R~ 23N 2WC 34G 39C 4.4 53G 5GY 5RE 5VS 6J9 AAEDW AALRI AAXUO ABOCM ACGFO ACVFH ADBBV ADCNI ADVLN AENEX AEUPX AFETI AFOSN AFPUW AGCQF AIGII AITUG AKBMS AKRWK AKYEP ALMA_UNASSIGNED_HOLDINGS AMRAJ BAWUL BTFSW CGR CS3 CUY CVF DIK DU5 E3Z EBS ECM EFKBS EIF EJD EX3 F5P FDB FRP GS5 GX1 H13 IH2 K-O KQ8 L7B LSO MJL N9A NPM OK1 P2P R.V RHI ROL SJN THE TR2 TWZ W2D W8F WH7 WOQ WOW X7M YHG YKV 7X8 |
| ID | FETCH-LOGICAL-c513t-c1a008295eea9cb3877457d1ab56a881befcd75e7d8c13f6536b5d73d7d76f9e2 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 43 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000611287300008&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1528-0020 |
| IngestDate | Sat Sep 27 16:52:01 EDT 2025 Mon Jul 21 06:07:07 EDT 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 2 |
| Language | English |
| License | 2021 by The American Society of Hematology. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c513t-c1a008295eea9cb3877457d1ab56a881befcd75e7d8c13f6536b5d73d7d76f9e2 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| OpenAccessLink | https://ashpublications.org/blood/article-pdf/137/2/168/1797389/bloodbld2020007702.pdf |
| PMID | 32877503 |
| PQID | 2439977924 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2439977924 pubmed_primary_32877503 |
| PublicationCentury | 2000 |
| PublicationDate | 2021-01-14 20210114 |
| PublicationDateYYYYMMDD | 2021-01-14 |
| PublicationDate_xml | – month: 01 year: 2021 text: 2021-01-14 day: 14 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | Blood |
| PublicationTitleAlternate | Blood |
| PublicationYear | 2021 |
| SSID | ssj0014325 |
| Score | 2.5376892 |
| Snippet | A majority of children and young adults with acute lymphoblastic leukemia (ALL) are cured with contemporary multiagent chemotherapy regimens. The high rate of... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 168 |
| SubjectTerms | Antineoplastic Combined Chemotherapy Protocols - administration & dosage Female Humans Maintenance Chemotherapy - methods Male Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - drug therapy Sex Characteristics |
| Title | Optimizing therapy in the modern age: differences in length of maintenance therapy in acute lymphoblastic leukemia |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/32877503 https://www.proquest.com/docview/2439977924 |
| Volume | 137 |
| WOSCitedRecordID | wos000611287300008&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1JS8QwFH6468Vl3DciiLcwk7ZpUi-ionhx9KAwtyHNgoNOq86MMP56XzItehEELyVQUkL6-N73luQDOGZOoJdMNY24lTRRGeKgNJxmCpEwEy7JW3kQmxDttux0svsq4Tao2iprTAxAbUrtc-TNyBNnITBcOHt9o141yldXKwmNaZiNkcp4qxad7ypCEgfRVXRRknpeVJcpZdQMbeEYHvqTKkKEpMovBDM4muuV_y5xFZYriknOJzaxBlO2aMD6eYHhdX9MTkho-gzZ9AbMX9Sjxcta-q0BC7dVxX0d3u8QU_q9T_RwZHJWa0x6hR-SfpBRIwhIp6TWWUHU8a-9PMvwiZSO9JW_kMLf6mF_zld6NLTkZYy2VOZI4HGpOGn0jEtQG_B4ffVweUMrnQaqOYuHVDMVjuhya1Wm81gipeTCMJXzVEnkxdZpI7gVRmoWu5THac6NiI0wInWZjTZhpigLuw3EOOtSp6WSCcNvREq3LGNCmYQJJJpsB47qre_invjihipsORp0vzd_B7Ym_6_7OrmwoxtjWOjrtbt_mL0HS5FvW2kxypJ9mHWIAvYA5vTHsDd4PwwGhs_2_e0XvHLb8w |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Optimizing+therapy+in+the+modern+age%3A+differences+in+length+of+maintenance+therapy+in+acute+lymphoblastic+leukemia&rft.jtitle=Blood&rft.au=Teachey%2C+David+T&rft.au=Hunger%2C+Stephen+P&rft.au=Loh%2C+Mignon+L&rft.date=2021-01-14&rft.eissn=1528-0020&rft.volume=137&rft.issue=2&rft.spage=168&rft_id=info:doi/10.1182%2Fblood.2020007702&rft_id=info%3Apmid%2F32877503&rft_id=info%3Apmid%2F32877503&rft.externalDocID=32877503 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1528-0020&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1528-0020&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1528-0020&client=summon |