Medical Research Council leukaemia trial--UKALL V: an attempt to reduce the immunosuppressive effects of therapy in childhood XXXX . Report to the Council by the Working Party on Leukaemia in Childhood.

@entity1 @entity981 @entity4446 @entity1891 @entity1499 @entity204 @entity617
The Medical Research Council UKALL V trial for @entity1 with standard-risk @entity981 ( @entity981 ) (aged 1 to 14 years, leucocyte count less than 20 X 10(9)/L) was designed to determine whether the immunosuppressive effects of treatment could be reduced without sacrifice of antileukemic effect by alterations in the type of continuing therapy or in fractionation of cranial irradiation. Remission was achieved in 496 @entity1 on standard induction therapy, and 309 @entity1 received 24 Gy of cranial irradiation in ten to 16 fractions over 21 days, and 174 received 21 Gy in five to nine fractions over 21 days. The type of radiotherapy administered had no influence on relapse at any site or rate of @entity204 in remission. All 496 @entity1 were randomized to receive chemotherapy for 2 or 3 years with @entity4446 and @entity1499 either as a continuous (group C) or a semicontinuous (group G) regimen or as a five-day pulse every 3 weeks (group I). All groups also received @entity1891 and @entity617 every 6 weeks. With a minimum follow-up of almost 7 years, @entity1 in group I had significantly fewer remission deaths (P = .025) but a much higher rate of bone marrow relapse than those in group C or G (P = .002). There was an overall benefit for 3 years of chemotherapy compared with 2 years, which in contrast to previous studies, was more apparent in @entity1 and in @entity1 in groups C and G. Testicular relapse occurred in 37 @entity1 , including 19 @entity1 off therapy, with a previously negative biopsy. The overall results confirmed the prognostic significance of initial leucocyte count, even among these standard-risk @entity1 , while @entity1 had a superior rate of disease-free survival, but not of hematologic remission. It is concluded that, even among standard-risk @entity1 , the prognosis is influenced by the height of the initial leukocyte count. While alterations in the fractionation of cranial irradiation do not appear to have influenced disease-free survival, intermittent continuing chemotherapy, although less immunosuppressive, is less effective than conventional continuous therapy in the treatment of @entity981 . In this study, 3 years of chemotherapy appeared superior to 2 years.
