Document Type

Article

Original Publication Date

1983

Journal/Book/Conference Title

The New England Journal of Medicine

Volume

308

Issue

9

First Page

477

Last Page

484

DOI of Original Publication

10.1056/NEJM198303033080902

Comments

Originally published at http://dx.doi.org/10.1056/NEJM198303033080902

Date of Submission

January 2015

Abstract

Abstract

We compared two regimens with respect to their ability to prolong disease-free survival in 506 children and adolescents with acute lymphocytic leukemia. All responders to induction therapy were randomized to treatment with 2400 rad of cranial irradiation plus intrathecal methotrexate or to treatment with intermediate-dose methotrexate plus intrathecal methotrexate, as prophylaxis for involvement of the central nervous system and other "sanctuary" areas. Patients were then treated with a standard maintenance regimen. Complete responders were stratified into either standard-risk or increased-risk groups on the basis of age and white-cell count at presentation.

Among patients with standard risk, hematologic relapses occurred in 9 of 117 given methotrexate and 24 of 120 given irradiation (P<0.01). The rate of Central-nervous-system relapse was higher in the methotrexate group (23 of 117) than in the irradiation group (8 of 120) (P = 0.01). Among patients with increased risk, radiation offered greater protection to the central nervous system than methotrexate (P = 0.03); there was no difference in the rate of hematologic relapse. In both risk strata the frequency of testicular relapse was significantly lower in the methotrexate group (1 patient) than the radiation group (10 patients) (P = 0.01).

Methotrexate offered better protection against systemic relapse in standard-risk patients and better protection against testicular relapse overall, but it offered less protection against relapses in the central nervous system than cranial irradiation. (N Engl J Med. 1983; 308:477–84.)

Rights

From The New England Journal of Medicine, Freeman, A.I., Weinberg, V., Brecher, M.L., et al., Comparison of Intermediate-Dose Methotrexate with Cranial Irradiation for the Post-Induction Treatment of Acute Lymphocytic Leukemia in Children, Vol. 308, Page 477, Copyright © 1983 Massachusetts Medical Society. Reprinted with permission.

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