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Comparison Of Intermediate-Dose Methotrexate With Cranial Irradiation For The Post-Induction Treatment Of Acute Lymphocytic Leukemia In Children, Arnold I. Freeman , M.D., Vivian Weinberg, Martin L. Brecher , M.D., Barbara Jones , M.D., Arvin S. Glicksman , M.D., Lucius F. Sinks , M.D., Marise Weil , M.D., Hansjuerg Pleuss , M.D., Juliet Hananian , M.D., E. Omer Burgert , Jr., M.D., Gerald S. Gilchrist , M.D., Thomas Necheles , M.D., Michael Harris , M.D., Faith Kung , M.D., Richard B. Patterson , M.D., Harold Maurer , M.D., Brigid Leventhal , M.D., Louise Chevalier , M.D., Edwin Forman , M.D., James F. Holland , M.D.

Pediatrics Publications

Abstract

We compared two regimens with respect to their ability to prolong disease-free survival in 506 children and adolescents with acute lymphocytic leukemia. All responders to induction therapy were randomized to treatment with 2400 rad of cranial irradiation plus intrathecal methotrexate or to treatment with intermediate-dose methotrexate plus intrathecal methotrexate, as prophylaxis for involvement of the central nervous system and other "sanctuary" areas. Patients were then treated with a standard maintenance regimen. Complete responders were stratified into either standard-risk or increased-risk groups on the basis of age and white-cell count at presentation.

Among patients with standard risk, hematologic relapses occurred …