Treatment for childhood acute lymphoblastic leukemia in Taiwan: Taiwan Pediatric Oncology Group ALL-2002 study emphasizing optimal reinduction therapy and central nervous system preventive therapy without cranial radiation
Meng-Ju Li
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
Search for more papers by this authorHsi-Che Liu
Department of Pediatrics, Mackay Memorial Hospital, Mackay Medical College, Taipei, Taiwan
Search for more papers by this authorHsiu-Ju Yen
Department of Pediatrics, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
Search for more papers by this authorTang-Her Jaing
Department of Hematology–Oncology, Chang Gung Children's Hospital–Linkou, Taoyuan, Taiwan
Search for more papers by this authorDong-Tsamn Lin
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorChao-Ping Yang
Department of Hematology–Oncology, Chang Gung Children's Hospital–Linkou, Taoyuan, Taiwan
Search for more papers by this authorKai-Hsin Lin
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorIou-Jih Hung
Department of Hematology–Oncology, Chang Gung Children's Hospital–Linkou, Taoyuan, Taiwan
Search for more papers by this authorShiann-Tarng Jou
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorMeng-Yao Lu
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorChih-Cheng Hsiao
Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Search for more papers by this authorChing-Tien Peng
Division of Pediatric Hematology & Oncology, China Medical University Children's Hospital, Taichung, Taiwan
Department of Biotechnology, Asia University, Wufeng, Taichung, Taiwan
Search for more papers by this authorTai-Tsung Chang
Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan
Search for more papers by this authorShih-Chung Wang
Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
Search for more papers by this authorMing-Tsan Lin
Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
Search for more papers by this authorJiann-Shiuh Chen
Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
Search for more papers by this authorTe-Kau Chang
Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
Search for more papers by this authorGiun-Yi Hung
Department of Pediatrics, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
Search for more papers by this authorKang-Hsi Wu
Division of Pediatric Hematology & Oncology, China Medical University Children's Hospital, Taichung, Taiwan
Search for more papers by this authorYung-Li Yang
Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorHsiu-Hao Chang
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorShih-Hsiang Chen
Department of Hematology–Oncology, Chang Gung Children's Hospital–Linkou, Taoyuan, Taiwan
Search for more papers by this authorTing-Chi Yeh
Department of Pediatrics, Mackay Memorial Hospital, Mackay Medical College, Taipei, Taiwan
Search for more papers by this authorChao-Neng Cheng
Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
Search for more papers by this authorPei-Chin Lin
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Search for more papers by this authorShyh-Shin Chiou
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Search for more papers by this authorJiunn-Ming Sheen
Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Search for more papers by this authorShin-Nan Cheng
Department of Pediatrics, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
Search for more papers by this authorShu-Huey Chen
Department of Pediatrics, Taipei Medical University–Shuang Ho Hospital, Taipei, Taiwan
Search for more papers by this authorYu-Hsiang Chang
Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Search for more papers by this authorWan-Ling Ho
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
Search for more papers by this authorYu-Hua Chao
Department of Pediatrics, Chung Shan Medical University Hospital, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
Search for more papers by this authorRong-Long Chen
Division of Pediatric Hematology and Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
Search for more papers by this authorBow-Wen Chen
Division of Pediatric Hematology and Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
Search for more papers by this authorJinn-Li Wang
Department of Pediatrics, Wanfang Hospital Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorYuh-Lin Hsieh
Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
Search for more papers by this authorYu-Mei Liao
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Search for more papers by this authorShang-Hsien Yang
Department of Pediatrics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
Search for more papers by this authorCorresponding Author
Der-Cherng Liang
Department of Pediatrics, Mackay Memorial Hospital, Mackay Medical College, Taipei, Taiwan
Correspondence
Der-Cherng Liang, Department of Pediatrics, Mackay Memorial Hospital, 92, Sec. 2, Chung-San N. Rd, Taipei 10449, Taiwan.
Email: [email protected]
Search for more papers by this authorMeng-Ju Li
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
Search for more papers by this authorHsi-Che Liu
Department of Pediatrics, Mackay Memorial Hospital, Mackay Medical College, Taipei, Taiwan
Search for more papers by this authorHsiu-Ju Yen
Department of Pediatrics, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
Search for more papers by this authorTang-Her Jaing
Department of Hematology–Oncology, Chang Gung Children's Hospital–Linkou, Taoyuan, Taiwan
Search for more papers by this authorDong-Tsamn Lin
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorChao-Ping Yang
Department of Hematology–Oncology, Chang Gung Children's Hospital–Linkou, Taoyuan, Taiwan
Search for more papers by this authorKai-Hsin Lin
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorIou-Jih Hung
Department of Hematology–Oncology, Chang Gung Children's Hospital–Linkou, Taoyuan, Taiwan
Search for more papers by this authorShiann-Tarng Jou
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorMeng-Yao Lu
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorChih-Cheng Hsiao
Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Search for more papers by this authorChing-Tien Peng
Division of Pediatric Hematology & Oncology, China Medical University Children's Hospital, Taichung, Taiwan
Department of Biotechnology, Asia University, Wufeng, Taichung, Taiwan
Search for more papers by this authorTai-Tsung Chang
Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan
Search for more papers by this authorShih-Chung Wang
Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
Search for more papers by this authorMing-Tsan Lin
Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
Search for more papers by this authorJiann-Shiuh Chen
Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
Search for more papers by this authorTe-Kau Chang
Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
Search for more papers by this authorGiun-Yi Hung
Department of Pediatrics, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
Search for more papers by this authorKang-Hsi Wu
Division of Pediatric Hematology & Oncology, China Medical University Children's Hospital, Taichung, Taiwan
Search for more papers by this authorYung-Li Yang
Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorHsiu-Hao Chang
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Search for more papers by this authorShih-Hsiang Chen
Department of Hematology–Oncology, Chang Gung Children's Hospital–Linkou, Taoyuan, Taiwan
Search for more papers by this authorTing-Chi Yeh
Department of Pediatrics, Mackay Memorial Hospital, Mackay Medical College, Taipei, Taiwan
Search for more papers by this authorChao-Neng Cheng
Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
Search for more papers by this authorPei-Chin Lin
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Search for more papers by this authorShyh-Shin Chiou
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Search for more papers by this authorJiunn-Ming Sheen
Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Search for more papers by this authorShin-Nan Cheng
Department of Pediatrics, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
Search for more papers by this authorShu-Huey Chen
Department of Pediatrics, Taipei Medical University–Shuang Ho Hospital, Taipei, Taiwan
Search for more papers by this authorYu-Hsiang Chang
Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Search for more papers by this authorWan-Ling Ho
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
Search for more papers by this authorYu-Hua Chao
Department of Pediatrics, Chung Shan Medical University Hospital, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
Search for more papers by this authorRong-Long Chen
Division of Pediatric Hematology and Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
Search for more papers by this authorBow-Wen Chen
Division of Pediatric Hematology and Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
Search for more papers by this authorJinn-Li Wang
Department of Pediatrics, Wanfang Hospital Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorYuh-Lin Hsieh
Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
Search for more papers by this authorYu-Mei Liao
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Search for more papers by this authorShang-Hsien Yang
Department of Pediatrics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
Search for more papers by this authorCorresponding Author
Der-Cherng Liang
Department of Pediatrics, Mackay Memorial Hospital, Mackay Medical College, Taipei, Taiwan
Correspondence
Der-Cherng Liang, Department of Pediatrics, Mackay Memorial Hospital, 92, Sec. 2, Chung-San N. Rd, Taipei 10449, Taiwan.
Email: [email protected]
Search for more papers by this authorMeng-Ju Li, Hsi-Che Liu, and Hsiu-Ju Yen contributed equally to this article.
[This article was corrected on 3 November 2016 because an abbreviation in the article title needed to be spelled out.]
Abstract
Background
Reinduction therapy has improved the outcomes in children with acute lymphoblastic leukemia (ALL). We sought to determine the optimal course(s) of reinduction therapy for standard-risk (SR, or “low-risk” in other groups) patients. Also, we evaluated outcomes using triple intrathecal therapy without cranial radiation (CrRT) for central nervous system (CNS) preventive therapy.
Procedure
From 2002 to 2012, all newly diagnosed children with ALL in Taiwan were enrolled in Taiwan Pediatric Oncology Group ALL-2002 protocol. SR patients were randomized to receive single or double reinduction courses. The patients enrolled before 2009 received CrRT, while those enrolled later did not. The Kaplan–Meier method was used to estimate survival rates and the difference between two groups was compared by the two-sided log-rank test.
Results
In 1,366 eligible patients, the 5-year overall survival (OS) was 81.6 ± 1.1% (standard error) and 5-year event-free survival (EFS) was 74.3 ± 1.2%. In SR patients, the 5-year OS for one and two reinduction courses was 91.6 ± 2.1% and 93.7 ± 1.8%, respectively, and the 5-year EFS was 85.2 ± 2.7% and 89.8 ± 2.3%, respectively. There were no significant differences in survival between these two groups. Patients with MLL or BCR-ABL1 had the worst outcomes: 5-year EFS was 23.4 and 31.8% and 5-year OS was 28.6 and 44.7%, respectively. There was no significant difference in CNS relapse or survival between the era with or without CrRT.
Conclusions
For SR patients, one-course reinduction was adequate. Triple intrathecal therapy alone successfully prevented CNS relapse.
Supporting Information
| Filename | Description |
|---|---|
| pbc26142-sup-0001-Figure.tif2.6 MB | Supplementary Figure S1. Road map of treatment regimens by risk groups |
| pbc26142-sup-0002-TableS1.docx20.2 KB | Supplementary Table S1. Treatment protocols of TPOG ALL-2002 SR |
| pbc26142-sup-0003-TableS2.docx19.7 KB | Supplementary Table S2. Treatment protocols of TPOG ALL-2002 HR |
| pbc26142-sup-0004-TableS3.docx18.7 KB | Supplementary Table S3. Treatment protocols of TPOG ALL-2002 VHR |
| pbc26142-sup-0005-TableS4.docx17.6 KB | Supplementary Table S4. Comparison of regimens in reinduction therapy |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Pui CH, Carroll WL, Meshinchi S, Arceci RJ. Biology, risk stratification, and therapy of pediatric acute leukemias: An update. J Clin Oncol. 2011: 29: 551–565.
- 2Moricke A, Zimmermann M, Reiter A, et al. Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000. Leukemia. 2010: 24: 265–284.
- 3Hunger SP, Lu X, Devidas M, et al. Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: A report from the children's oncology group. J Clin Oncol. 2012: 30: 1663–1669.
- 4Vora A, Goulden N, Mitchell C, et al. Augmented post-remission therapy for a minimal residual disease-defined high-risk subgroup of children and young people with clinical standard-risk and intermediate-risk acute lymphoblastic leukaemia (UKALL 2003): A randomised controlled trial. Lancet Oncol. 2014: 15: 809–818.
- 5Schrappe M, Reiter A, Zimmermann M, et al. Long-term results of four consecutive trials in childhood ALL performed by the ALL-BFM study group from 1981 to 1995. Berlin-Frankfurt-Munster. Leukemia. 2000: 14: 2205–2222.
- 6Reiter A, Schrappe M, Ludwig WD, et al. Chemotherapy in 998 unselected childhood acute lymphoblastic leukemia patients. Results and conclusions of the multicenter trial ALL-BFM 86. Blood. 1994: 84: 3122–3133.
- 7Vora A, Goulden N, Wade R, et al. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): A randomised controlled trial. Lancet Oncol. 2013: 14: 199–209.
- 8Chessells JM, Bailey C, Richards SM. Intensification of treatment and survival in all children with lymphoblastic leukaemia: Results of UK Medical Research Council trial UKALL X. Medical Research Council Working Party on Childhood Leukaemia. Lancet. 1995: 345: 143–148.
- 9Lange BJ, Bostrom BC, Cherlow JM, et al. Double-delayed intensification improves event-free survival for children with intermediate-risk acute lymphoblastic leukemia: A report from the Children's Cancer Group. Blood. 2002: 99: 825–833.
- 10Pui CH, Pei D, Campana D, et al. A revised definition for cure of childhood acute lymphoblastic leukemia. Leukemia. 2014: 28: 2336–2343.
- 11Stary J, Zimmermann M, Campbell M, et al. Intensive chemotherapy for childhood acute lymphoblastic leukemia: Results of the randomized intercontinental trial ALL IC-BFM 2002. J Clin Oncol. 2014: 32: 174–184.
- 12Pui CH, Cheng C, Leung W, et al. Extended follow-up of long-term survivors of childhood acute lymphoblastic leukemia. N Engl J Med. 2003: 349: 640–649.
- 13Hijiya N, Hudson MM, Lensing S, et al. Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia. JAMA 2007: 297: 1207–1215.
- 14Waber DP, Turek J, Catania L, et al. Neuropsychological outcomes from a randomized trial of triple intrathecal chemotherapy compared with 18 Gy cranial radiation as CNS treatment in acute lymphoblastic leukemia: Findings from Dana-Farber Cancer Institute ALL Consortium Protocol 95-01. J Clin Oncol. 2007: 25: 4914–4921.
- 15Geenen MM, Cardous-Ubbink MC, Kremer LC, et al. Medical assessment of adverse health outcomes in long-term survivors of childhood cancer. JAMA 2007: 297: 2705–2715.
- 16Liu HC, Yeh TC, Hou JY, et al. Triple intrathecal therapy alone with omission of cranial radiation in children with acute lymphoblastic leukemia. J Clin Oncol. 2014: 32: 1825–1829.
- 17Liang DC, Yang CP, Lin DT, et al. Long-term results of Taiwan Pediatric Oncology Group studies 1997 and 2002 for childhood acute lymphoblastic leukemia. Leukemia 2010: 24: 397–405.
- 18Mahmoud HH, Rivera GK, Hancock ML, et al. Low leukocyte counts with blast cells in cerebrospinal fluid of children with newly diagnosed acute lymphoblastic leukemia. N Engl J Med. 1993: 329: 314–319.
- 19Kalbfleisch JD, Prentice RL. The Statistical Analysis of Failure Time Data. New York, NY: Wiley; 2002.
10.1002/9781118032985 Google Scholar
- 20Pui CH. Reducing delayed intensification therapy in childhood ALL. Lancet Oncol. 2013: 14: 178–179.
- 21Pui CH, Evans WE. Treatment of acute lymphoblastic leukemia. N Engl J Med. 2006: 354: 166–178.
- 22Pui CH, Pei D, Sandlund JT, et al. Long-term results of St Jude Total Therapy Studies 11, 12, 13A, 13B, and 14 for childhood acute lymphoblastic leukemia. Leukemia 2010: 24: 371–382.
- 23Goldie JH, Coldman AJ. The genetic origin of drug resistance in neoplasms: Implications for systemic therapy. Cancer Res. 1984: 44: 3643–3653.
- 24Norton L, Simon R. Tumor size, sensitivity to therapy, and design of treatment schedules. Cancer Treat Rep. 1977: 61: 1307–1317.
- 25Matloub Y, Bostrom BC, Hunger SP, et al. Escalating intravenous methotrexate improves event-free survival in children with standard-risk acute lymphoblastic leukemia: A report from the Children's Oncology Group. Blood 2011: 118: 243–251.
- 26Vrooman LM, Stevenson KE, Supko JG, et al. Postinduction dexamethasone and individualized dosing of Escherichia coli l-asparaginase each improve outcome of children and adolescents with newly diagnosed acute lymphoblastic leukemia: Results from a randomized study–Dana-Farber Cancer Institute ALL Consortium Protocol 00-01. J Clin Oncol. 2013: 31: 1202–1210.
- 27Veerman AJ, Kamps WA, van den Berg H, et al. Dexamethasone-based therapy for childhood acute lymphoblastic leukaemia: Results of the prospective Dutch Childhood Oncology Group (DCOG) protocol ALL-9 (1997–2004). Lancet Oncol. 2009: 10: 957–966.
- 28Yamaji K, Okamoto T, Yokota S, et al. Minimal residual disease-based augmented therapy in childhood acute lymphoblastic leukemia: A report from the Japanese Childhood Cancer and Leukemia Study Group. Pediatr Blood Cancer 2010: 55: 1287–1295.
- 29Bhojwani D, Yang JJ, Pui CH. Biology of childhood acute lymphoblastic leukemia. Pediatr Clin North Am. 2015: 62: 47–60.
- 30Pui CH, Yang JJ, Hunger SP, et al. Childhood acute lymphoblastic leukemia: Progress through collaboration. J Clin Oncol. 2015: 33: 2938–2948.
- 31Pui CH, Howard SC. Current management and challenges of malignant disease in the CNS in paediatric leukaemia. Lancet Oncol. 2008: 9: 257–268.
- 32Gajjar A, Harrison PL, Sandlund JT, et al. Traumatic lumbar puncture at diagnosis adversely affects outcome in childhood acute lymphoblastic leukemia. Blood 2000: 96: 3381–3384.
- 33 Dutch Childhood Oncology Group, te Loo DM, Kamps WA, van der Does-van den Berg A, van Wering ER, de Graaf SS. Prognostic significance of blasts in the cerebrospinal fluid without pleiocytosis or a traumatic lumbar puncture in children with acute lymphoblastic leukemia: Experience of the Dutch Childhood Oncology Group. J Clin Oncol 2006: 24: 2332–2336.
- 34Burger B, Zimmermann M, Mann G, et al. Diagnostic cerebrospinal fluid examination in children with acute lymphoblastic leukemia: Significance of low leukocyte counts with blasts or traumatic lumbar puncture. J Clin Oncol 2003: 21: 184–188.
- 35Pui CH, Evans WE. Acute lymphoblastic leukemia. N Engl J Med. 1998: 339: 605–615.
- 36Pui CH, Campana D, Pei D, et al. Treating childhood acute lymphoblastic leukemia without cranial irradiation. N Engl J Med. 2009: 360: 2730–2741.
- 37Manabe A, Tsuchida M, Hanada R, et al. Delay of the diagnostic lumbar puncture and intrathecal chemotherapy in children with acute lymphoblastic leukemia who undergo routine corticosteroid testing: Tokyo Children's Cancer Study Group study L89-12. J Clin Oncol. 2001: 19: 3182–3187.
- 38Hasegawa D, Manabe A, Ohara A, et al. The utility of performing the initial lumbar puncture on day 8 in remission induction therapy for childhood acute lymphoblastic leukemia: TCCSG L99-15 study. Pediatr Blood Cancer 2012: 58: 23–30.
