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Evidence summaries

Duration and Intensity of Maintenance Chemotherapy in Acute Lymphoblastic Leukaemia in Children

Intensive reinduction chemotherapy produces an absolute improvement of about 4% in long-term survival, but extra one or two years of low-dose maintenance are not beneficial. Level of evidence: "A"

A systematic review 1 including 42 RCTs with a total of 11,941 children was abstracted in DARE.

Deaths during remission were increased by longer maintenance (2.7% vs 1.2%), vincristine plus prednisone/prednisolone pulses (VP) (4.0% vs 3.2%), and intensive reinduction (4.8% vs 3.3%), but the increases were counterbalanced by reductions in relapses. The total number of relapses or deaths was significantly reduced by longer maintenance (23.3% vs 27.6%), VP pulses (31.2% vs 40.4%) and intensive reinduction (27.8% vs 35.8%). Many of those who relapsed were successfully re-treated. Only for intensive reinduction was overall survival significantly improved (18.5% vs 22.3%).

    References

    • Duration and intensity of maintenance chemotherapy in acute lymphoblastic leukaemia: overview of 42 trials involving 12 000 randomised children. Childhood ALL Collaborative Group. Lancet 1996 Jun 29;347(9018):1783-8. [PubMed] [DARE]

Primary/Secondary Keywords