Successful toxicity reduction during delayed intensification in the non-high-risk arm of Malaysia-Singapore Acute Lymphoblastic Leukaemia 2010 study

• Published in: European journal of cancer (1990) 2021-01, Vol.142, p.92-101
• Main Authors: Oh, Bernice L.Z., Lee, Shawn H.R., Foo, Koon M., Chiew, Kean H., Seeto, Zelia Z.L., Chen, Zhi W., Neoh, Cheryl C.C., Liew, Germaine S.M., Eng, Jing J., Lam, Joyce C.M., Chan, Yiong H., Quah, Thuan C., Tan, Ah M., Yeoh, Allen E.J.
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukaemia; Acute lymphoblastic leukemia; Amplification; Asparaginase; Bacteremia; Child; Child, Preschool; Childhood; Cytarabine; Delayed intensification; Doxorubicin; Female; Fever; History, 21st Century; Humans; Infant; Infective complications; Leukemia; Malaysia; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Risk; Singapore; Survival; Toxicity; Treatment toxicity; Vincristine
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2020.10.010

In non–high-risk (non-HR) patients, the Malaysia-Singapore Acute Lymphoblastic Leukaemia 2003 (MS2003) study achieved good outcomes. However, its delayed-intensification (DI) phase, comprising repeated blocks of protocol III (2003-PIII), was toxic and caused significant treatment delays. The successor MS2010 study attempted to lower DI toxicity by replacing myelosuppressive drugs (doxorubicin, cytarabine) with vincristine and asparaginase. We analysed 1748 admissions for fever in 315 Singapore children with non-HR acute lymphoblastic leukaemia (ALL) (MS2003, n = 183; MS2010, n = 132), comprising 76% of the total cohort (n = 413), to study the impact of these changes. The new 2010-PVa which has no doxorubicin, was associated with significantly fewer hospitalisations due to fever (0.08 versus 0.30 admissions per block [A/blk], p