Outstanding outcomes with two low intensity regimens in children with low-risk B-ALL: a report from COG AALL0932

Schore RJ, Angiolillo AL, Kairalla JA, Devidas M, Rabin KR, Zweidler-McKay P, Borowitz MJ, Wood B, Carroll AJ, Heerema NA, Relling MV, Hitzler J, Kadan-Lottick NS, Maloney K, Wang C, Carroll WL, Winick NJ, Raetz EA, Loh ML, Hunger SP. Outstanding outcomes with two low intensity regimens in children with low-risk B-ALL: a report from COG AALL0932. Leukemia. 2023 Jun;37(6):1375-1378. doi: 10.1038/s41375-023-01870-8. Epub 2023 Mar 25. PubMed PMID: 36966262; PubMed Central PMCID: PMC10503688.

Acute lymphoblastic leukemia (ALL), the most common childhood malignancy, has excellent outcomes overall with contemporary therapy.(1) The combination of clinical features, sentinel genetic lesions, and day 8 peripheral blood and end of induction (EOI) bone marrow minimal residual disease (MRD) can be used to risk stratify patients based on risk of relapse.(2, 3) The Children’s Oncology Group (COG) retrospectively identified low risk (LR) subsets of standard-risk (SR) B-ALL patients with 5-year event-free survival (EFS) >95% and overall survival (OS) >97% treated with a 3-drug induction and post-induction intensification strategies with either intermediate dose methotrexate (ID MTX) without anthracyclines or alkylating agents (P9904), or a COG-modified Berlin-Frankfurt-Muenster (BFM) approach (CCG-1991).(2, 4, 5) COG AALL0932 was designed to prospectively confirm whether patients with low risk (LR) B-ALL could achieve a 5-year disease-free survival (DFS) of ≥95% with either of two regimens previously associated with outstanding DFS and overall survival (OS) and limited short- and long-term toxicity.