The cure rate of childhood acute lymphoblas-retrieval rate is 49 Ϯ 10%. For all patients, the tic leukemia (ALL) has improved dramatically.
12-year event-free survival was 37 Ϯ 3.6% and Still there is a paucity of long-term data. With the overall survival was 49 Ϯ 3.5%. There were the improving cure rate, the quality of life and two cases of second malignancies reported in avoidance of second cancers have become im-3,502 person-years of survival. Both occurred portant concerns.
following salvage therapy. There was no evi-We evaluated 596 children and adolescents dence of an excessive number of second priwith ALL on Cancer and Leukemia Group B maries over the general population of children. 7611 (CALGB 7611) who were randomized There were no reported instances of clinical carbetween 1976 and 1979 to receive intermedi-diopathy. ate-dose methotrexate (IDM) plus intrathecal After a median follow-up of 11 years, there methotrexate (IT MTX) or cranial radiation (CRT) have been no reports of cardiopathy and no plus IT MTX.
evidence of an increased risk of second cancers After 10 additional years of follow-up, the in children treated on CALGB 7611. While the pattern and significance of the results reported overall outcome is not what would be expected in 1983 are confirmed. IDM offered better with modern therapy, one can conclude that hematologic protection (P Ͻ 0.0006), better tes-CRT offered better CNS protection, but IDM ofticular protection (P ϭ 0.002), but CRT offered fered better systemic and testicular protection. better central nervous system (CNS) protection A small risk of second cancers or cardiac dys-(P Ͻ 0.0001). The retrieval rate for the 231 pa-function may be acceptable with therapies tients who relapsed while on therapy or within which produce long-term documented survival 6 months of elective cessation of therapy is benefits. Med. Pediatr. Oncol. 28:98-107 20 Ϯ 5%. For the 33 patients who relapsed mor-ᮊ 1997 Wiley-Liss, Inc. ethan 6 months after cessation of therapy, the