D. H. Berry

Factors influencing survival in pediatric acute leukemia. The SWCCSG experience, 1958–1970

From 1958 through 1970 a total of 1,024 patients was entered on the 7 clinical studies of the Southwest Cancer Chemotherapy Study Group for newly diagnosed cases of acute leukemia. A review of these cases was undertaken to determine the important factors, other than therapy, influencing survival. The most important variables in terms of survival prognosis were found to be age at diagnosis, histologic type of leukemia, and initial peripheral blood leukocyte count. The influence of these variables appeared to persist for at least 5 years following diagnosis. Based on these variables, a simple heuristic approach was taken to define prognostic groups of patients. The patients race, initial platelet count, hemorrhagic status, and enlargement status of liver, spleen, and nodes were of additional prognostic value, but there appeared to be no prognostic significance in the patients sex, initial hemoglobin value, or percent of blast cells in the bone marrow.

THE RESPONSE OF ACUTE CHILDHOOD LEUKEMIA TO AN INITIAL AND A SECOND COURSE OF PREDNISONE.

In untreated acute childhood leukemia the number, duration, and quality of remissions induced by prednisone when used alone and again for the second time were determined. The remission rates for therapy in 46 children with untreated disease, and in 41 children in relapse for the second time, were 59 per cent and 46 per cent, respectively. The median duration of remission in the untreated patients was 38 days; for patients in relapse it was 35 days. The median time to detect remission was 28 days in each group.

Comparison of prednisolone, vincristine, methotrexate, and 6‐mercaptopurine vs. vincristine and prednisone induction therapy in childhood acute leukemia

This study was designed to compare vincristine‐prednisone (VP) vs. prednisolone, vincristine, methotrexate, and 6‐mercaptopurine (POMP) with respect to response rates and toxicity for induction therapy in acute leukemia. Children with acute lymphoblastic, acute undifferentiated, or acute stem cell leukemia were stratified on the basis of initial leukocyte count and age, then randomly assigned to POMP or VP induction therapy. On the POMP regime, 19/34 (56%) achieved complete remission (CR), 7 achieved partial remission (PR), and 5 did not respond (NR). Three died prior to day 25 of the study. On the VP regime, 37/39 (95%) had CR, and 2 NR. On the VP regime neither sepsis nor toxicity were significant problems. The POMP regime had a higher incidence of sepsis and other toxicities frequently causing therapy interruption, but not unequivocally causing the poor response rate. Several other factors were evaluated as possible causes for the lack of response to POMP therapy.

Combination of vincristine and prednisonein therapy of acute leukemia in children

Summary Sixty-four children with acute leukemia in relapse following prior therapy were treated with vincristine and prednisone in combination. Of 53 evaluatable cases, 18 children (34 per cent) achieved complete remissions and 20 (38 per cent) partial remissions. There were 28 (53 per cent) bone marrow (M-1) remissions. Two of the 53 were classified as acute granulocytic leukemia; neither patient responded to therapy. Response rate was higher (79 per cent) inthose presumed to be steroid sensitive as compared to that in those presumed to be steroid resistant (40 per cent). Patients who were 9 years of age or older had a significantly responsiveness in this study to nature of and response to previous treatment was examined.