Isolated late testicular relapse of B-cell acute lymphoblastic leukemia treated with intensive systemic chemotherapy and response-based testicular radiation

A Children's Oncology Group study

Julio Barredo, Caroline Hastings, Xiamin Lu, F. Meenakshi Devidas, Yichen Chen, F. Daniel Armstrong, Naomi Winick, Brent Lee Wood, Rochelle Yanofsky, Mignon Loh, Julie M. Gastier-Foster, Dean Thomas Jorstad, Robert Marcus, Kim Ritchey, William L. Carrol, Stephen P. Hunger

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The incidence of isolated testicular relapse (ITR) of acute lymphoblastic leukemia (ALL) has decreased with contemporary treatment strategies, but outcomes are suboptimal with a 58% 5-year overall survival (OS). This study aimed to improve outcome in patients with ITR of B-cell ALL (B-ALL) occurring after 18 months of first clinical remission using intensive systemic chemotherapy and to decrease long-term sequelae by limiting use of testicular radiation. Procedure: Forty patients in first ITR of B-ALL were enrolled. Induction (dexamethasone, vincristine, daunorubicin, and intrathecal triple therapy) was preceded by one dose of high-dose methotrexate (MTX, 5 g/m2). Following induction, 25 of 26 patients who had persistent testicular enlargement underwent testicular biopsy. Eleven had biopsy-proven disease and received bilateral testicular radiation (24 Gy), whereas twenty-nine did not. Results: Overall 5-year event-free survival (EFS)/OS was 65.0 ± 8.8%/73.1 ± 8.3%, with 5-year EFS 62.1 ± 11.0% vs. 72.7 ± 14.4% for patients who did not receive radiation therapy (XRT) (n = 29) compared with those who did (n = 11), respectively (P = 0.64). There were six second bone marrow relapses and six second ITRs. The proportion of second relapses was similar in the patients that received testicular radiation and those who did not. However, the 5-year OS was similar for patients who did not receive XRT (72.6 ± 10.2%) compared with those who did (72.7 ± 14.4%) (P = 0.85). Conclusions: A 5-year OS rate of 73.1 ± 8.3% was obtained in children with first ITR of B-ALL occurring after 18 months of CR1 (length of first clinical remission) using intensive chemotherapy and limiting testicular radiation.

Original languageEnglish (US)
JournalPediatric Blood and Cancer
DOIs
StateAccepted/In press - Jan 1 2018

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
B-Lymphocytes
Radiation
Recurrence
Drug Therapy
Disease-Free Survival
Survival
Biopsy
Radiation Dosage
Daunorubicin
Vincristine
Methotrexate
Dexamethasone
Radiotherapy
Survival Rate
Bone Marrow
Incidence

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Isolated late testicular relapse of B-cell acute lymphoblastic leukemia treated with intensive systemic chemotherapy and response-based testicular radiation : A Children's Oncology Group study. / Barredo, Julio; Hastings, Caroline; Lu, Xiamin; Devidas, F. Meenakshi; Chen, Yichen; Daniel Armstrong, F.; Winick, Naomi; Wood, Brent Lee; Yanofsky, Rochelle; Loh, Mignon; Gastier-Foster, Julie M.; Jorstad, Dean Thomas; Marcus, Robert; Ritchey, Kim; Carrol, William L.; Hunger, Stephen P.

In: Pediatric Blood and Cancer, 01.01.2018.

Research output: Contribution to journalArticle

Barredo, Julio ; Hastings, Caroline ; Lu, Xiamin ; Devidas, F. Meenakshi ; Chen, Yichen ; Daniel Armstrong, F. ; Winick, Naomi ; Wood, Brent Lee ; Yanofsky, Rochelle ; Loh, Mignon ; Gastier-Foster, Julie M. ; Jorstad, Dean Thomas ; Marcus, Robert ; Ritchey, Kim ; Carrol, William L. ; Hunger, Stephen P. / Isolated late testicular relapse of B-cell acute lymphoblastic leukemia treated with intensive systemic chemotherapy and response-based testicular radiation : A Children's Oncology Group study. In: Pediatric Blood and Cancer. 2018.
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title = "Isolated late testicular relapse of B-cell acute lymphoblastic leukemia treated with intensive systemic chemotherapy and response-based testicular radiation: A Children's Oncology Group study",
abstract = "Background: The incidence of isolated testicular relapse (ITR) of acute lymphoblastic leukemia (ALL) has decreased with contemporary treatment strategies, but outcomes are suboptimal with a 58{\%} 5-year overall survival (OS). This study aimed to improve outcome in patients with ITR of B-cell ALL (B-ALL) occurring after 18 months of first clinical remission using intensive systemic chemotherapy and to decrease long-term sequelae by limiting use of testicular radiation. Procedure: Forty patients in first ITR of B-ALL were enrolled. Induction (dexamethasone, vincristine, daunorubicin, and intrathecal triple therapy) was preceded by one dose of high-dose methotrexate (MTX, 5 g/m2). Following induction, 25 of 26 patients who had persistent testicular enlargement underwent testicular biopsy. Eleven had biopsy-proven disease and received bilateral testicular radiation (24 Gy), whereas twenty-nine did not. Results: Overall 5-year event-free survival (EFS)/OS was 65.0 ± 8.8{\%}/73.1 ± 8.3{\%}, with 5-year EFS 62.1 ± 11.0{\%} vs. 72.7 ± 14.4{\%} for patients who did not receive radiation therapy (XRT) (n = 29) compared with those who did (n = 11), respectively (P = 0.64). There were six second bone marrow relapses and six second ITRs. The proportion of second relapses was similar in the patients that received testicular radiation and those who did not. However, the 5-year OS was similar for patients who did not receive XRT (72.6 ± 10.2{\%}) compared with those who did (72.7 ± 14.4{\%}) (P = 0.85). Conclusions: A 5-year OS rate of 73.1 ± 8.3{\%} was obtained in children with first ITR of B-ALL occurring after 18 months of CR1 (length of first clinical remission) using intensive chemotherapy and limiting testicular radiation.",
author = "Julio Barredo and Caroline Hastings and Xiamin Lu and Devidas, {F. Meenakshi} and Yichen Chen and {Daniel Armstrong}, F. and Naomi Winick and Wood, {Brent Lee} and Rochelle Yanofsky and Mignon Loh and Gastier-Foster, {Julie M.} and Jorstad, {Dean Thomas} and Robert Marcus and Kim Ritchey and Carrol, {William L.} and Hunger, {Stephen P.}",
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T1 - Isolated late testicular relapse of B-cell acute lymphoblastic leukemia treated with intensive systemic chemotherapy and response-based testicular radiation

T2 - A Children's Oncology Group study

AU - Barredo, Julio

AU - Hastings, Caroline

AU - Lu, Xiamin

AU - Devidas, F. Meenakshi

AU - Chen, Yichen

AU - Daniel Armstrong, F.

AU - Winick, Naomi

AU - Wood, Brent Lee

AU - Yanofsky, Rochelle

AU - Loh, Mignon

AU - Gastier-Foster, Julie M.

AU - Jorstad, Dean Thomas

AU - Marcus, Robert

AU - Ritchey, Kim

AU - Carrol, William L.

AU - Hunger, Stephen P.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: The incidence of isolated testicular relapse (ITR) of acute lymphoblastic leukemia (ALL) has decreased with contemporary treatment strategies, but outcomes are suboptimal with a 58% 5-year overall survival (OS). This study aimed to improve outcome in patients with ITR of B-cell ALL (B-ALL) occurring after 18 months of first clinical remission using intensive systemic chemotherapy and to decrease long-term sequelae by limiting use of testicular radiation. Procedure: Forty patients in first ITR of B-ALL were enrolled. Induction (dexamethasone, vincristine, daunorubicin, and intrathecal triple therapy) was preceded by one dose of high-dose methotrexate (MTX, 5 g/m2). Following induction, 25 of 26 patients who had persistent testicular enlargement underwent testicular biopsy. Eleven had biopsy-proven disease and received bilateral testicular radiation (24 Gy), whereas twenty-nine did not. Results: Overall 5-year event-free survival (EFS)/OS was 65.0 ± 8.8%/73.1 ± 8.3%, with 5-year EFS 62.1 ± 11.0% vs. 72.7 ± 14.4% for patients who did not receive radiation therapy (XRT) (n = 29) compared with those who did (n = 11), respectively (P = 0.64). There were six second bone marrow relapses and six second ITRs. The proportion of second relapses was similar in the patients that received testicular radiation and those who did not. However, the 5-year OS was similar for patients who did not receive XRT (72.6 ± 10.2%) compared with those who did (72.7 ± 14.4%) (P = 0.85). Conclusions: A 5-year OS rate of 73.1 ± 8.3% was obtained in children with first ITR of B-ALL occurring after 18 months of CR1 (length of first clinical remission) using intensive chemotherapy and limiting testicular radiation.

AB - Background: The incidence of isolated testicular relapse (ITR) of acute lymphoblastic leukemia (ALL) has decreased with contemporary treatment strategies, but outcomes are suboptimal with a 58% 5-year overall survival (OS). This study aimed to improve outcome in patients with ITR of B-cell ALL (B-ALL) occurring after 18 months of first clinical remission using intensive systemic chemotherapy and to decrease long-term sequelae by limiting use of testicular radiation. Procedure: Forty patients in first ITR of B-ALL were enrolled. Induction (dexamethasone, vincristine, daunorubicin, and intrathecal triple therapy) was preceded by one dose of high-dose methotrexate (MTX, 5 g/m2). Following induction, 25 of 26 patients who had persistent testicular enlargement underwent testicular biopsy. Eleven had biopsy-proven disease and received bilateral testicular radiation (24 Gy), whereas twenty-nine did not. Results: Overall 5-year event-free survival (EFS)/OS was 65.0 ± 8.8%/73.1 ± 8.3%, with 5-year EFS 62.1 ± 11.0% vs. 72.7 ± 14.4% for patients who did not receive radiation therapy (XRT) (n = 29) compared with those who did (n = 11), respectively (P = 0.64). There were six second bone marrow relapses and six second ITRs. The proportion of second relapses was similar in the patients that received testicular radiation and those who did not. However, the 5-year OS was similar for patients who did not receive XRT (72.6 ± 10.2%) compared with those who did (72.7 ± 14.4%) (P = 0.85). Conclusions: A 5-year OS rate of 73.1 ± 8.3% was obtained in children with first ITR of B-ALL occurring after 18 months of CR1 (length of first clinical remission) using intensive chemotherapy and limiting testicular radiation.

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