Successful toxicity reduction during delayed intensification in the non-high-risk arm of Malaysia-Singapore Acute Lymphoblastic Leukaemia 2010 study

Oh BLZ 1 , Lee SHR 1 , Foo KM 2 , Chiew KH 1 , Seeto ZZL 3 , Chen ZW 1 Show all authors , Neoh CCC 4 , Liew GSM 2 , Eng JJ 2 , Lam JCM 2 , Chan YH 5 , Quah TC 1 , Tan AM 2 , Yeoh AEJ 6

Affiliations 

  • 1 Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University Singapore, Singapore
  • 2 Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, Singapore
  • 3 Department of Paediatrics, Yong Loo Lin School of Medicine, National University Singapore, Singapore
  • 4 Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
  • 5 Biostatistics Unit, Yong Loo Lin School of Medicine, National University Singapore, Singapore
  • 6 Viva-University Children's Cancer Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University Singapore, Singapore. Electronic address: allen.yeoh@nus.edu.sg
Eur J Cancer, 2021 01;142:92-101.
PMID: 33246161 DOI: 10.1016/j.ejca.2020.10.010

Abstract

In non-high-risk (non-HR) patients, the Malaysia-Singapore Acute Lymphoblastic Leukaemia 2003 (MS2003) study achieved good outcomes. However, its delayed-intensification (DI) phase, comprising repeated blocks of protocol III (2003-PIII), was toxic and caused significant treatment delays. The successor MS2010 study attempted to lower DI toxicity by replacing myelosuppressive drugs (doxorubicin, cytarabine) with vincristine and asparaginase.

PATIENTS AND METHODS: We analysed 1748 admissions for fever in 315 Singapore children with non-HR acute lymphoblastic leukaemia (ALL) (MS2003, n = 183; MS2010, n = 132), comprising 76% of the total cohort (n = 413), to study the impact of these changes.

RESULTS: The new 2010-PVa which has no doxorubicin, was associated with significantly fewer hospitalisations due to fever (0.08 versus 0.30 admissions per block [A/blk], p 

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