Intensified PEG-L-asparaginase and antimetabolite-based therapy for treatment of higher risk precursor-B acute lymphoblastic leukemia: a report from the Children's Oncology Group.


Journal Article

The Pediatric Oncology Group 9203 pilot protocol was designed to determine the feasibility of delivering 29 biweekly doses of polyethylene glycol (PEG)-L-asparaginase, on a backbone of intensive multiagent antimetabolite-based consolidation and maintenance in higher risk B-precursor acute lymphoblastic leukemia. Between June 1992 and August 1993, 34 patients were enrolled on this limited institution pilot. The 5-year event-free survival (+/-standard error) and overall survival (+/-standard error) were 68+/-8% and 76+/-7%, respectively. Excessive toxicities attributed to PEG-L-asparaginase and myelosuppression associated with cytosine arabinoside were encountered during consolidation resulting in early study closure and modification of therapy for those already enrolled. Ninety-two percent of methotrexate/cytosine arabinoside cycles were associated with grades 3 to 4 myelosuppression, and 24% resulted in delays in therapy of more than 7 days. Fifteen PEG-L-asparaginase related toxicities occurred in 13 patients (8 allergy, 4 pancreas, 2 central nervous system, and 1 hemorrhage). Intensification of therapy with PEG-L-asparaginase resulted in event-free survival and overall survival comparable to other studies of the same time period without the use of agents associated with long-term complications, such as anthracyclines, epipodophyllotoxins, and alkylating agents. However, excessive toxicity occurred with intensified PEG-L-asparaginase and antimetabolite based therapy delivered on this schedule.

Full Text

Duke Authors

Cited Authors

  • Salzer, WL; Devidas, M; Shuster, JJ; Wang, C; Chauvenet, A; Asselin, BL; Camitta, BM; Kurtzberg, J; Children's Oncology Group,

Published Date

  • June 2007

Published In

Volume / Issue

  • 29 / 6

Start / End Page

  • 369 - 375

PubMed ID

  • 17551397

Pubmed Central ID

  • 17551397

International Standard Serial Number (ISSN)

  • 1077-4114

Digital Object Identifier (DOI)

  • 10.1097/MPH.0b013e3180640d54


  • eng

Conference Location

  • United States