Frontiers in Pediatrics (Oct 2016)

Shorter maintenance therapy in childhood Acute Lymphoblastic Leukemia. The experience of the prospective, randomized Brazilian GBTLI ALL-93 protocol.

  • Silvia Regina Brandalise,
  • Marcos Borato Viana,
  • Vitória Régia Pereira Pinheiro,
  • Núbia Mendonça,
  • Luiz Fernando Lopes,
  • Waldir Veiga Pereira,
  • Maria Lúcia de Martino Lee,
  • Elitânia Marinho Pontes,
  • Gláucia Perini Zouain-Figueiredo,
  • Alita da Cunha Andrade Cirne Azevedo,
  • Maria Zélia Fernandes,
  • Nilma Pimentel,
  • Hilda Maria Oliveira,
  • Sônia Rossi Vianna,
  • Fernando de Almeida Werneck,
  • Carlos Alberto Scrideli,
  • Maria Nunes Álvares,
  • Érica Boldrini,
  • Sandra Regina Loggetto,
  • Paula Bruniera,
  • Maria José Mastellaro,
  • Eni Souza,
  • Rogério Agenor Araújo,
  • Flávia Bandeira,
  • Doralice Marvulle Tan,
  • Nelson Aquino de Carvalho,
  • Maria Alessandra Silva Salgado

DOI
https://doi.org/10.3389/fped.2016.00110
Journal volume & issue
Vol. 4

Abstract

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Maintenance therapy is an important phase of the childhood ALL treatment, requiring 2-year long therapy adherence of the patients and families. Weekly methotrexate (MTX) with daily 6-mercaptopurine (6MP) constitutes the backbone of maintenance therapy. Reduction in the maintenance therapy could overweight problems related with poverty of children with ALL living in Limited-Income countries (LIC). Objective: To compare, prospectively, the EFS rates of children with ALL treated according to two maintenance regimens: 18 vs 24 months duration. Materials and Methods: From October 1993 to September 1999, 867 consecutive untreated ALL patients 10 years and high WBC at diagnosis). Overall death in remission rate was 6.85% (56 patients). Deaths during maintenance were 13 in group 1 and 12 in group 2, all due to infection. Over 15 years of follow-up, two patients both from Group 2 presented a second malignancy (Hodgkin’s disease and thyroid carcinoma) after 8.3 and 11 years off therapy, respectively. Conclusion: Six-month reduction of maintenance therapy in ALL children treated according to the GBTLI ALL-93 protocol, provided the same overall outcome as 2-year duration regimen.

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