Early intensification with post-induction myeloid-type chemotherapy does not significantly improve outcomes for infant acute lymphoblastic leukaemia (ALL), the Interfant-06 study has reported.
The study, comprising 18 international study groups, assigned 651 infants
- Low risk (LR): KMT2A germline
- High risk (HR): KMT2A rearranged and older than six months with white blood cell (WBC) count ≥300×109/L or a poor prednisone response.
- Medium risk (MR): all other KMT2A-rearranged cases.
Patients in the MR and HR groups were assigned to receive the lymphoid low-dose cytosine arabinoside [araC], 6-mercaptopurine, cyclophosphamide or experimental myeloid courses, namely: araC, daunorubicin, etoposide (ADE) and mitoxantrone, araC, etoposide (MAE).
Six-year event-free survival (EFS) and overall survival (OS) were 46.1 per cent and 58.2 per cent, respectively. The six-year probability of disease-free survival was comparable for the randomised arms (ADE+MAE 39.3% vs IB 36.8%; P=.47).
The six-year EFS rate of patients in the HR group intended for stem cell transplant (SCT) was 20.9 per cent. However, only 46 per cent received SCT because many had early events.
KMT2A rearrangement was the strongest prognostic factor for EFS, followed by age, WBC count and prednisone response.