A new study led by researchers from the Manchester Cancer Research Institute (UK) has provided information that may assist clinicians in controlling relapse in cases of childhood acute lymphoblastic leukemia (ALL).
The results, published recently in PLoS One, indicate that mitoxantrone treatment is associated with better outcomes when utilized to treat individuals with a CNS relapse of ALL, compared with treatment with idarubicin.
“Survival rates for leukemia have improved dramatically over the last 50 years. However, there are still some children who see their disease come back. We wanted to investigate the potential benefits of different therapies targeted at the CNS in these patients,” commented Vaskar Saha of The University of Manchester (UK), leader of the study.
This investigation involved analyses of data from the international ALL R3 trial, which was carried out from 2003 to 2011, in order to uncover more information concerning the outcomes of children with ALL who experienced a CNS relapse. The ALL R3 trial compared the use of the two agents mitoxantrone and idarubicin in this clinical setting, while also comparing stem cell transplants with chemoradiotherapy.
The results of the study suggested that patients treated with mitoxantrone had a better outcome than those treated with idarubicin. These results were conclusive enough to prompt early termination of this aspect of the trial. Additionally, the trial results also demonstrated a potential benefit to patients of a donor stem cell transplant; however, this was only in those whose disease had relapsed within 18 months of diagnosis or <6 months after completing their first treatment.
“This study suggests that a simple approach of offering a stem cell transplant to all CNS relapse patients – except those relapsing more than six months after treatment – would improve outcomes. Sadly, we saw worse outcomes for children over ten years old. We are now running a new trial to see if nontoxic targeted drugs can improve treatment for older patients with relapsed ALL,” added Saha.