Science Research

Throughout the years many technological advancements have helped scientists improve the outcomes of the treatment of acute lymphocytic leukemia. Despite the advances in the treatments some patients continue to succumb to their disease. Many scientists have been focusing their attention on trying to create treatments for patients with poor prognosis. The P9906 study was desighned to determine if the augmented Berlin Frankfurt Muenster (ABFM) regimen produces better results in treatment of a modified ABFM regimen in a group of patients with B precursor ALL than previously used treatments. A number of variables predicted of a poor outcome. These variables included : NCI high risk (based on age and White Blood Cell count), genotype ( philidelphia chromosome or hypodiploidy) and a slow response to induction chemotherapy. The ABFM regimen improves the outcome of NCI high risk ALL patients with either a slow or rapid earrly response to a 1 week of multiagent chemotherapy. The patients compose of approximately 12% children and adolescents with B precursor ALL and had a 4 year event- free survivial of 44% based on earlier Pediatric Oncology Group (POG) studies. Another objective of this study included to investigate the prognostic significance of Minimal Residual Disease (MRD). Their results demonstrated that the use of ABFM therapy significantly improved outcome. Despite the improved outcome there was a high rate of isolated central nervous system (CNS) relapse. Patients who were MRD positive on the eigth day (blood) or 29th day (bone marrow) of induction therapy had worse outcomes. On day 29, bone marrow and minimal residual disease were highly predictive of marrow but not CNS relapse.

Within this experiment much work was put into gathering the materials and methodology. Written informed consent was received from the guardians or parents of each person. Patients with B precursor ALL ages 1-21.99 years were first enrolled on the COG P9900 classification / induction study and received induction chemptherapy accorcing the NCI high risk group. Each patient was given 4 drugs : prednisone, vincrostine, aparaginase, and duanorbicm. Patients with 5-25% marrow blasts at the end of induction (day 29) received an addition 2 weeks of therapy with the same drugs. Patients who had less than 5% marrow blasts at day 29 or day 43 were elegible to participate in this experiment. These patients either met the schuster age/sex/WBC criteria for higher risk or they had five or more WBC with blasts present on the initial cerebrospinal fluid examination (CNS3 Leukemia), testicular leukemia , or an MLL translocation. Patients with philidelphia chromosome or hypodiploidy were not elegible. This study was the first time that the augmented Berlin Frankfurt Muenster regimen developed by the Childrens Oncology Group was used in a POG trial. This resulted in a couple changes made from the baseline ABFM regimen used in 1882 and 1961.