RESUMO
Between 1981 and 2000, 6 609 children (<18 years of age) were treated in 5 consecutive trials of the Berlin-Frankfurt-Münster (BFM) study group for childhood acute lymphoblastic leukemia (ALL). Patients were treated in up to 82 centers in Germany, Austria, and Switzerland. Probability of 10-year event-free survival (survival) improved from 65% (77%) in study ALL-BFM 81-78% (85%) in ALL-BFM 95. In parallel to relapse reduction, major efforts focused on reducing acute and late toxicity through advanced risk adaptation of treatment. The major findings derived from these ALL-BFM trials were as follows: 1) preventive cranial radiotherapy could be safely reduced to 12 Gy in T-ALL and high-risk ALL patients and eliminated in non-high-risk non-T-ALL patients, if it was replaced by high-dose and intrathecal methotrexate; 2) omission of delayed reintensification severely impaired outcome of low-risk patients; 3) 6 months less maintenance therapy caused an increase in systemic relapses; 4) slow response to an initial 7-day prednisone window was identified as adverse prognostic factor; 5) condensed induction therapy resulted in a significant improvement of outcome; 6) the daunorubicin dose in induction could be safely reduced in low-risk patients; 7) intensification of consolidation/reintensification treatment led to considerable improvement of outcome in high-risk patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/história , Oncologia/história , Pediatria/história , Leucemia-Linfoma Linfoblástico de Células Precursoras/história , Ensaios Clínicos Controlados Aleatórios como Assunto/história , Asparaginase/história , Criança , Ciclofosfamida/história , Citarabina/história , Daunorrubicina/história , Europa (Continente) , Alemanha , História do Século XX , História do Século XXI , Humanos , Mercaptopurina/história , Metotrexato/história , Prednisona/história , Vincristina/históriaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/história , Pesquisa Biomédica/história , Docentes de Medicina/história , Pediatria/história , Leucemia-Linfoma Linfoblástico de Células Precursoras/história , Asparaginase/história , Criança , Daunorrubicina/história , Alemanha , História do Século XX , História do Século XXI , Humanos , Prednisona/história , Vincristina/históriaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/história , Quimioterapia de Indução/história , Quimioterapia de Indução/métodos , Oncologia/história , Pediatria/história , Leucemia-Linfoma Linfoblástico de Células Precursoras/história , Asparaginase/história , Criança , Ciclofosfamida/história , Citarabina/história , Dexametasona/história , Doxorrubicina/história , Alemanha , História do Século XX , História do Século XXI , Humanos , Tioguanina/história , Vincristina/históriaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/história , Docentes de Medicina/história , Leucemia/história , Linfoma/história , Oncologia/história , Pediatria/história , Ciência/história , Asparaginase/história , Criança , Daunorrubicina/história , Alemanha , História do Século XX , História do Século XXI , Humanos , Prednisona/história , Vincristina/históriaRESUMO
This article highlights the important collaboration between the U.S. NCI in Bethesda, Maryland and the Istituto Tumori in Milan, Italy that had a major impact on the development of curative regimens for breast cancer, Hodgkin's disease and diffuse large B cell lymphoma.In addition to his contribution to developing new therapies, Gianni Bonadonna played an important role in bringing highly focused, disciplined, ethical clinical trials to the European continent.