Queensland Childrens Cancer Center

Brisbane, Australia

Queensland Childrens Cancer Center

Brisbane, Australia

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Masurekar A.N.,Institute of Cancer | Parker C.A.,Institute of Cancer | Shanyinde M.,University of Oxford | Moorman A.V.,Northumbria University | And 13 more authors.
PLoS ONE | Year: 2014

The outcomes of Central Nervous System (CNS) relapses in children with acute lymphoblastic leukaemia (ALL) treated in the ALL R3 trial, between January 2003 and March 2011 were analysed. Patients were risk stratified, to receive a matched donor allogeneic transplant or fractionated cranial irradiation with continued treatment for two years. A randomisation of Idarubicin with Mitoxantrone closed in December 2007 in favour of Mitoxantrone. The estimated 3-year progression free survival for combined and isolated CNS disease were 40.6% (25·1, 55·6) and 38.0% (26.2, 49.7) respectively. Univariate analysis showed a significantly better survival for age <10 years, progenitor-B cell disease, good-risk cytogenetics and those receiving Mitoxantrone. Adjusting for these variables (age, time to relapse, cytogenetics, treatment drug and gender) a multivariate analysis, showed a poorer outcome for those with combined CNS relapse (HR 2·64, 95% CI 1·32, 5·31, p=0·006 for OS). ALL R3 showed an improvement in outcome for CNS relapses treated with Mitoxantrone compared to Idarubicin; a potential benefit for matched donor transplant for those with very early and early isolated-CNS relapses. © 2014 Masurekar et al.


PubMed | Southampton General Hospital, University of New South Wales, Southmead Hospital, University of Manchester and 8 more.
Type: Clinical Trial | Journal: PloS one | Year: 2014

The outcomes of Central Nervous System (CNS) relapses in children with acute lymphoblastic leukaemia (ALL) treated in the ALL R3 trial, between January 2003 and March 2011 were analysed. Patients were risk stratified, to receive a matched donor allogeneic transplant or fractionated cranial irradiation with continued treatment for two years. A randomisation of Idarubicin with Mitoxantrone closed in December 2007 in favour of Mitoxantrone. The estimated 3-year progression free survival for combined and isolated CNS disease were 40.6% (251, 556) and 38.0% (26.2, 49.7) respectively. Univariate analysis showed a significantly better survival for age <10 years, progenitor-B cell disease, good-risk cytogenetics and those receiving Mitoxantrone. Adjusting for these variables (age, time to relapse, cytogenetics, treatment drug and gender) a multivariate analysis, showed a poorer outcome for those with combined CNS relapse (HR 264, 95% CI 132, 531, p=0006 for OS). ALL R3 showed an improvement in outcome for CNS relapses treated with Mitoxantrone compared to Idarubicin; a potential benefit for matched donor transplant for those with very early and early isolated-CNS relapses.Controlled-Trials.com ISRCTN45724312.


Woodward E.,Leeds Teaching Hospitals NHS Trust | Woodward E.,University of Leeds | Jessop M.,Leeds Teaching Hospitals NHS Trust | Jessop M.,Queensland Childrens Cancer Center | And 3 more authors.
Annals of Oncology | Year: 2011

Background: Late effects (LEs) after cancer treatment are increasing. After childhood cancer, substantial risks include physical, psychological and social LE and vary with age. Teenagers and young adults (TYA) present with particular cancers; their risk of LE may relate to cancer site, treatment or their age itself. The LEs after TYA-onset cancers are described in relation to age at diagnosis of primary tumour. Patients and methods: Data were extracted from Medline English language articles, 1999-2009. Keywords were late effect/s, late toxicity and survivor and the frequent TYA cancer sites. Only those articles that reported the relation between LEs risks with age at diagnosis were included. Results: The majority of known LEs are described after TYA cancer. No study primarily aimed to relate TYA age to LEs. Many studies did not report LE by age. TYA-specific risks are seen in cardiac toxicity, second malignancies, pulmonary complications and psychosocial difficulties when compared with older or younger cancer survivors. Conclusions: TYA age brings specific LE risks after cancer. Prospective population-based collection of LE data after TYA cancer will inform the development of appropriate services to effectively manage LE. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

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