FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 338:1663-1671 June 4, 1998 Number 23 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Children with high-risk acute lymphoblastic leukemia (ALL) who have a slow response to initial chemotherapy (more than 25 percent blasts in the bone marrow on day 7) have a poor outcome despite intensive therapy. We conducted a randomized trial in which such patients were treated with either an augmented intensive regimen of post-induction chemotherapy or a standard regimen of intensive post-induction chemotherapy.

Methods Between January 1991 and June 1995, 311 children with newly diagnosed ALL who were either 1 to 9 years of age with white-cell counts of at least 50,000 per cubic millimeter or 10 years of age or older, had a slow response to initial therapy, and entered remission at the end of induction chemotherapy were randomly assigned to receive standard therapy (156 children) or augmented therapy (155). Those with lymphomatous features were excluded. Event-free survival and overall survival were assessed from the end of induction treatment.

Results The outcome at five years was significantly better in the augmented-therapy group than in the standard-therapy group (Kaplan–Meier estimate of event-free survival [±SD]: 75.0±3.8 vs. 55.0±4.5 percent, P<0.001; overall survival: 78.4±3.7 vs. 66.7±4.2 percent, P=0.02). The difference between treatments was most pronounced among patients one to nine years of age, all of whom had white-cell counts of at least 50,000 per cubic millimeter (P<0.001). Risk factors for an adverse event in the entire cohort included a white-cell count of 200,000 per cubic millimeter or higher (P=0.004), race other than black or white (P<0.001), and the presence of a t(9;22) translocation (P=0.007). The toxic effects of augmented therapy were considerable but manageable.

Conclusions Augmented post-induction chemotherapy results in an excellent outcome for most patients with high-risk ALL and a slow response to initial therapy.

Source Information

From the Section of Pediatric Hematology–Oncology, University of Chicago, Chicago (J.B.N.); the Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles (H.N.S.); Group Operations Center, Children's Cancer Group, Arcadia, Calif. (H.N.S., M.G.S.); the Division of Pediatric Bone Marrow Transplantation, University of Iowa Hospital and Clinics, Iowa City (M.E.T.); the Department of Radiation Oncology, Long Beach Memorial Medical Center, Long Beach, Calif. (J.M.C.); the Department of Pediatric Hematology–Oncology, Vanderbilt University, Nashville (J.N.L.); the Department of Pediatric Hematology–Oncology, Oregon Health Sciences University, and Doernbecher Children's Hospital, Portland (L.W.); Children's Cancer Group Acute Lymphoblastic Leukemia Biology Reference Laboratory and Wayne Hughes Institute, St. Paul, Minn. (F.M.U.); and the Department of Pediatrics, University of Wisconsin, Madison (P.S.G.).

Address reprint requests to Dr. Nachman at the Children's Cancer Group, P.O. Box 60012, Arcadia, CA 91066-6012.

Full Text of this Article

Related Letters:

Augmented Post-Induction Therapy in Childhood Lymphoblastic Leukemia
Donadieu J., Hill C., Nachman J. B., Sather H. N., Gaynon P. S.
Extract | Full Text  
N Engl J Med 1998; 339:1080-1081, Oct 8, 1998. Correspondence

This article has been cited by other articles:

• Bhojwani, D., Kang, H., Menezes, R. X., Yang, W., Sather, H., Moskowitz, N. P., Min, D.-J., Potter, J. W., Harvey, R., Hunger, S. P., Seibel, N., Raetz, E. A., Pieters, R., Horstmann, M. A., Relling, M. V., den Boer, M. L., Willman, C. L., Carroll, W. L. (2008). Gene Expression Signatures Predictive of Early Response and Outcome in High-Risk Childhood Acute Lymphoblastic Leukemia: A Children's Oncology Group Study on Behalf of the Dutch Childhood Oncology Group and the German Cooperative Study Group for Childhood Acute Lymphoblastic Leukemia. JCO 26: 4376-4384 [Abstract] [Full Text]  
• Lecuyer, L., Chevret, S., Guidet, B., Aegerter, P., Martel, P., Schlemmer, B., Azoulay, E. (2008). Case volume and mortality in haematological patients with acute respiratory failure. Eur Respir J 32: 748-754 [Abstract] [Full Text]  
• Stock, W., La, M., Sanford, B., Bloomfield, C. D., Vardiman, J. W., Gaynon, P., Larson, R. A., Nachman, J. (2008). What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children's Cancer Group and Cancer and Leukemia Group B studies. Blood 112: 1646-1654 [Abstract] [Full Text]  
• Tucci, F., Arico, M. (2008). Treatment of pediatric acute lymphoblastic leukemia. haematol 93: 1124-1128 [Full Text]  
• Borowitz, M. J., Devidas, M., Hunger, S. P., Bowman, W. P., Carroll, A. J., Carroll, W. L., Linda, S., Martin, P. L., Pullen, D. J., Viswanatha, D., Willman, C. L., Winick, N., Camitta, B. M., for the Children's Oncology Group, (2008). Clinical significance of minimal residual disease in childhood acute lymphoblastic leukemia and its relationship to other prognostic factors: a Children's Oncology Group study. Blood 111: 5477-5485 [Abstract] [Full Text]  
• Moricke, A., Reiter, A., Zimmermann, M., Gadner, H., Stanulla, M., Dordelmann, M., Loning, L., Beier, R., Ludwig, W.-D., Ratei, R., Harbott, J., Boos, J., Mann, G., Niggli, F., Feldges, A., Henze, G., Welte, K., Beck, J.-D., Klingebiel, T., Niemeyer, C., Zintl, F., Bode, U., Urban, C., Wehinger, H., Niethammer, D., Riehm, H., Schrappe, M., for the German-Austrian-Swiss ALL-BFM Study Group, (2008). Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95. Blood 111: 4477-4489 [Abstract] [Full Text]  
• Seibel, N. L., Steinherz, P. G., Sather, H. N., Nachman, J. B., DeLaat, C., Ettinger, L. J., Freyer, D. R., Mattano, L. A. Jr, Hastings, C. A., Rubin, C. M., Bertolone, K., Franklin, J. L., Heerema, N. A., Mitchell, T. L., Pyesmany, A. F., La, M. K., Edens, C., Gaynon, P. S. (2008). Early postinduction intensification therapy improves survival for children and adolescents with high-risk acute lymphoblastic leukemia: a report from the Children's Oncology Group. Blood 111: 2548-2555 [Abstract] [Full Text]  
• von Stackelberg, A., Hartmann, R., Buhrer, C., Fengler, R., Janka-Schaub, G., Reiter, A., Mann, G., Schmiegelow, K., Ratei, R., Klingebiel, T., Ritter, J., Henze, G., for the ALL-REZ BFM Study Group, (2008). High-dose compared with intermediate-dose methotrexate in children with a first relapse of acute lymphoblastic leukemia. Blood 111: 2573-2580 [Abstract] [Full Text]  
• Kang, M. H., Kang, Y. H., Szymanska, B., Wilczynska-Kalak, U., Sheard, M. A., Harned, T. M., Lock, R. B., Reynolds, C. P. (2007). Activity of vincristine, L-ASP, and dexamethasone against acute lymphoblastic leukemia is enhanced by the BH3-mimetic ABT-737 in vitro and in vivo. Blood 110: 2057-2066 [Abstract] [Full Text]  
• Winter, S. S., Jiang, Z., Khawaja, H. M., Griffin, T., Devidas, M., Asselin, B. L., Larson, R. S. (2007). Identification of genomic classifiers that distinguish induction failure in T-lineage acute lymphoblastic leukemia: a report from the Children's Oncology Group. Blood 110: 1429-1438 [Abstract] [Full Text]  
• Butturini, A. M., Dorey, F. J., Lange, B. J., Henry, D. W., Gaynon, P. S., Fu, C., Franklin, J., Siegel, S. E., Seibel, N. L., Rogers, P. C., Sather, H., Trigg, M., Bleyer, W. A., Carroll, W. L. (2007). Obesity and Outcome in Pediatric Acute Lymphoblastic Leukemia. JCO 25: 2063-2069 [Abstract] [Full Text]  
• Kishi, S., Cheng, C., French, D., Pei, D., Das, S., Cook, E. H., Hijiya, N., Rizzari, C., Rosner, G. L., Frudakis, T., Pui, C.-H., Evans, W. E., Relling, M. V. (2007). Ancestry and pharmacogenetics of antileukemic drug toxicity. Blood 109: 4151-4157 [Abstract] [Full Text]  
• Douer, D., Yampolsky, H., Cohen, L. J., Watkins, K., Levine, A. M., Periclou, A. P., Avramis, V. I. (2007). Pharmacodynamics and safety of intravenous pegaspargase during remission induction in adults aged 55 years or younger with newly diagnosed acute lymphoblastic leukemia. Blood 109: 2744-2750 [Abstract] [Full Text]  
• Acun, H., Kemikler, G., Karadeniz, A. (2007). Dosimetric analysis of thyroid doses from total cranial irradiation. Radiat Prot Dosimetry 123: 498-504 [Abstract] [Full Text]  
• Schultz, K. R., Pullen, D. J., Sather, H. N., Shuster, J. J., Devidas, M., Borowitz, M. J., Carroll, A. J., Heerema, N. A., Rubnitz, J. E., Loh, M. L., Raetz, E. A., Winick, N. J., Hunger, S. P., Carroll, W. L., Gaynon, P. S., Camitta, B. M. (2007). Risk- and response-based classification of childhood B-precursor acute lymphoblastic leukemia: a combined analysis of prognostic markers from the Pediatric Oncology Group (POG) and Children's Cancer Group (CCG). Blood 109: 926-935 [Abstract] [Full Text]  
• Ribera, J.-M., Ortega, J.-J., Oriol, A., Bastida, P., Calvo, C., Perez-Hurtado, J.-M., Gonzalez-Valentin, M.-E., Martin-Reina, V., Molines, A., Ortega-Rivas, F., Moreno, M.-J., Rivas, C., Egurbide, I., Heras, I., Poderos, C., Martinez-Revuelta, E., Guinea, J.-M., del Potro, E., Deben, G. (2007). Comparison of Intensive Chemotherapy, Allogeneic, or Autologous Stem-Cell Transplantation As Postremission Treatment for Children With Very High Risk Acute Lymphoblastic Leukemia: PETHEMA ALL-93 Trial. JCO 25: 16-24 [Abstract] [Full Text]  
• Schrauder, A., Reiter, A., Gadner, H., Niethammer, D., Klingebiel, T., Kremens, B., Peters, C., Ebell, W., Zimmermann, M., Niggli, F., Ludwig, W.-D., Riehm, H., Welte, K., Schrappe, M. (2006). Superiority of Allogeneic Hematopoietic Stem-Cell Transplantation Compared With Chemotherapy Alone in High-Risk Childhood T-Cell Acute Lymphoblastic Leukemia: Results From ALL-BFM 90 and 95. JCO 24: 5742-5749 [Abstract] [Full Text]  
• Eapen, M., Raetz, E., Zhang, M.-J., Muehlenbein, C., Devidas, M., Abshire, T., Billett, A., Homans, A., Camitta, B., Carroll, W. L., Davies, S. M., for the Children's Oncology Group and the Center f, (2006). Outcomes after HLA-matched sibling transplantation or chemotherapy in children with B-precursor acute lymphoblastic leukemia in a second remission: a collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research. Blood 107: 4961-4967 [Abstract] [Full Text]  
• Sterba, J., Dusek, L., Demlova, R., Valik, D. (2006). Pretreatment Plasma Folate Modulates the Pharmacodynamic Effect of High-Dose Methotrexate in Children with Acute Lymphoblastic Leukemia and Non-Hodgkin Lymphoma: "Folate Overrescue" Concept Revisited. Clin. Chem. 52: 692-700 [Abstract] [Full Text]  
• Pui, C.-H., Evans, W. E. (2006). Treatment of Acute Lymphoblastic Leukemia. NEJM 354: 166-178 [Full Text]  
• Cho, R., Stork, L. C., Gaynon, P. S., Sather, H. N., La, M. K., Hutchinson, R. J. (2005). Early Marrow Response in CCG-1952: The Prognostic Impact of Poor Day 14 Marrow Response Is Powerful and Only Partially Reversible with Intensified Therapy.. ASH ANNUAL MEETING ABSTRACTS 106: 867-867 [Abstract]  
• Thiery, G., Azoulay, E., Darmon, M., Ciroldi, M., De Miranda, S., Levy, V., Fieux, F., Moreau, D., Le Gall, J. R., Schlemmer, B. (2005). Outcome of Cancer Patients Considered for Intensive Care Unit Admission: A Hospital-Wide Prospective Study. JCO 23: 4406-4413 [Abstract] [Full Text]  
• Rocha, J. C. C., Cheng, C., Liu, W., Kishi, S., Das, S., Cook, E. H., Sandlund, J. T., Rubnitz, J., Ribeiro, R., Campana, D., Pui, C.-H., Evans, W. E., Relling, M. V. (2005). Pharmacogenetics of outcome in children with acute lymphoblastic leukemia. Blood 105: 4752-4758 [Abstract] [Full Text]  
• Pearce, J. M., Sills, R. H. (2005). Consultation with the Specialist: Childhood Leukemia. Pediatr. Rev. 26: 96-104 [Full Text]  
• Hawkins, D. S., Park, J. R., Thomson, B. G., Felgenhauer, J. L., Holcenberg, J. S., Panosyan, E. H., Avramis, V. I. (2004). Asparaginase Pharmacokinetics After Intensive Polyethylene Glycol-Conjugated L-Asparaginase Therapy for Children with Relapsed Acute Lymphoblastic Leukemia. Clin. Cancer Res. 10: 5335-5341 [Abstract] [Full Text]  
• Huang, M. S., Hasserjian, R. P. (2004). Case 19-2004 - A 12-Year-Old Boy with Fatigue and Eosinophilia. NEJM 350: 2604-2612 [Full Text]  
• Pui, C.-H., Schrappe, M., Ribeiro, R. C., Niemeyer, C. M. (2004). Childhood and Adolescent Lymphoid and Myeloid Leukemia. ASH Education Book 2004: 118-145 [Abstract] [Full Text]  
• Carroll, W. L. (2003). Race and Outcome in Childhood Acute Lymphoblastic Leukemia. JAMA 290: 2061-2063 [Full Text]  
• Kees, U. R., Ford, J., Watson, M., Murch, A., Ringner, M., Walker, R. L., Meltzer, P. (2003). Gene Expression Profiles in a Panel of Childhood Leukemia Cell Lines Mirror Critical Features of the Disease. Molecular Cancer Therapeutics 2: 671-677 [Abstract] [Full Text]  
• Hutchinson, R. J., Gaynon, P. S., Sather, H., Bertolone, S. J., Cooper, H. A., Tannous, R., Wells, L. M., Heerema, N. A., Sailer, S., Trigg, M. E. (2003). Intensification of Therapy for Children With Lower-Risk Acute Lymphoblastic Leukemia: Long-Term Follow-Up of Patients Treated on Children's Cancer Group Trial 1881. JCO 21: 1790-1797 [Abstract] [Full Text]  
• Schiffer, C. A. (2003). Differences in Outcome in Adolescents With Acute Lymphoblastic Leukemia: A Consequence of Better Regimens? Better Doctors? Both?. JCO 21: 760-761 [Full Text]  
• Boissel, N., Auclerc, M.-F., Lheritier, V., Perel, Y., Thomas, X., Leblanc, T., Rousselot, P., Cayuela, J.-M., Gabert, J., Fegueux, N., Piguet, C., Huguet-Rigal, F., Berthou, C., Boiron, J.-M., Pautas, C., Michel, G., Fiere, D., Leverger, G., Dombret, H., Baruchel, A. (2003). Should Adolescents With Acute Lymphoblastic Leukemia Be Treated as Old Children or Young Adults? Comparison of the French FRALLE-93 and LALA-94 Trials. JCO 21: 774-780 [Abstract] [Full Text]  
• Marshall, G. M., Haber, M., Kwan, E., Zhu, L., Ferrara, D., Xue, C., Brisco, M. J., Sykes, P. J., Morley, A., Webster, B., Dalla Pozza, L., Waters, K., Norris, M. D. (2003). Importance of Minimal Residual Disease Testing During the Second Year of Therapy for Children With Acute Lymphoblastic Leukemia. JCO 21: 704-709 [Abstract] [Full Text]  
• Carroll, W. L., Bhojwani, D., Min, D.-J., Raetz, E., Relling, M., Davies, S., Downing, J. R., Willman, C. L., Reed, J. C. (2003). Pediatric Acute Lymphoblastic Leukemia. ASH Education Book 2003: 102-131 [Abstract] [Full Text]  
• Moos, P. J., Raetz, E. A., Carlson, M. A., Szabo, A., Smith, F. E., Willman, C., Wei, Q., Hunger, S. P., Carroll, W. L. (2002). Identification of Gene Expression Profiles That Segregate Patients with Childhood Leukemia. Clin. Cancer Res. 8: 3118-3130 [Abstract] [Full Text]  
• Bhatia, S., Sather, H. N., Heerema, N. A., Trigg, M. E., Gaynon, P. S., Robison, L. L. (2002). Racial and ethnic differences in survival of children with acute lymphoblastic leukemia. Blood 100: 1957-1964 [Abstract] [Full Text]  
• Katzenstein, H. M., London, W. B., Douglass, E. C., Reynolds, M., Plaschkes, J., Finegold, M. J., Bowman, L. C. (2002). Treatment of Unresectable and Metastatic Hepatoblastoma: A Pediatric Oncology Group Phase II Study. JCO 20: 3438-3444 [Abstract] [Full Text]  
• Davies, S. M., Bhatia, S., Ross, J. A., Kiffmeyer, W. R., Gaynon, P. S., Radloff, G. A., Robison, L. L., Perentesis, J. P. (2002). Glutathione S-transferase genotypes, genetic susceptibility, and outcome of therapy in childhood acute lymphoblastic leukemia. Blood 100: 67-71 [Abstract] [Full Text]  
• Bhatia, S., Sather, H. N., Pabustan, O. B., Trigg, M. E., Gaynon, P. S., Robison, L. L. (2002). Low incidence of second neoplasms among children diagnosed with acute lymphoblastic leukemia after 1983. Blood 99: 4257-4264 [Abstract] [Full Text]  
• Lange, B. J., Bostrom, B. C., Cherlow, J. M., Sensel, M. G., La, M. K. L., Rackoff, W., Heerema, N. A., Wimmer, R. S., Trigg, M. E., Sather, H. N. (2002). Double-delayed intensification improves event-free survival for children with intermediate-risk acute lymphoblastic leukemia: a report from the Children's Cancer Group. Blood 99: 825-833 [Abstract] [Full Text]  
• Gaynon, P. S., Bostrom, B. C., Hutchinson, R. J., Lange, B. J., Nachman, J. B., Steinherz, P. G., Sensel, M. G., Lee, M. K., Stram, D. O., Sather, H. N. (2001). Duration of Hospitalization as a Measure of Cost on Children's Cancer Group Acute Lymphoblastic Leukemia Studies. JCO 19: 1916-1925 [Abstract] [Full Text]  
• Silverman, L. B., Gelber, R. D., Dalton, V. K., Asselin, B. L., Barr, R. D., Clavell, L. A., Hurwitz, C. A., Moghrabi, A., Samson, Y., Schorin, M. A., Arkin, S., Declerck, L., Cohen, H. J., Sallan, S. E. (2001). Improved outcome for children with acute lymphoblastic leukemia: results of Dana-Farber Consortium Protocol 91-01. Blood 97: 1211-1218 [Abstract] [Full Text]  
• Greenberg, P. L., Gordeuk, V., Issaragrisil, S., Siritanaratkul, N., Fucharoen, S., Ribeiro, R. C. (2001). Major Hematologic Diseases in the Developing World-- New Aspects of Diagnosis and Management of Thalassemia, Malarial Anemia, and Acute Leukemia. ASH Education Book 2001: 479-498 [Abstract] [Full Text]  
• Heerema, N. A., Sather, H. N., Sensel, M. G., Lee, M. K., Hutchinson, R. J., Nachman, J. B., Reaman, G. H., Lange, B. J., Steinherz, P. G., Bostrom, B. C., Gaynon, P. S., Uckun, F. M. (2000). Abnormalities of Chromosome Bands 13q12 to 13q14 in Childhood Acute Lymphoblastic Leukemia. JCO 18: 3837-3844 [Abstract] [Full Text]  
• Wheeler, K. A., Richards, S. M., Bailey, C. C., Gibson, B., Hann, I. M., Hill, F. G. H., Chessells, J. M. (2000). Bone marrow transplantation versus chemotherapy in the treatment of very high-risk childhood acute lymphoblastic leukemia in first remission: results from Medical Research Council UKALL X and XI. Blood 96: 2412-2418 [Abstract] [Full Text]  
• Mattano, L. A. Jr, Sather, H. N., Trigg, M. E., Nachman, J. B. (2000). Osteonecrosis as a Complication of Treating Acute Lymphoblastic Leukemia in Children: A Report From the Children's Cancer Group. JCO 18: 3262-3272 [Abstract] [Full Text]  
• Friedmann, A. M., Weinstein, H. J. (2000). The Role of Prognostic Features in the Treatment of Childhood Acute Lymphoblastic Leukemia. The Oncologist 5: 321-328 [Abstract] [Full Text]  
• Chessells, J. M (2000). Recent advances in management of acute leukaemia. Arch. Dis. Child. 82: 438-442 [Abstract] [Full Text]  
• Schrappe, M., Reiter, A., Ludwig, W.-D., Harbott, J., Zimmermann, M., Hiddemann, W., Niemeyer, C., Henze, G., Feldges, A., Zintl, F., Kornhuber, B., Ritter, J., Welte, K., Gadner, H., Riehm, H. (2000). Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: results of trial ALL-BFM 90. Blood 95: 3310-3322 [Abstract] [Full Text]  
• Heerema, N. A., Sather, H. N., Sensel, M. G., Zhang, T., Hutchinson, R. J., Nachman, J. B., Lange, B. J., Steinherz, P. G., Bostrom, B. C., Reaman, G. H., Gaynon, P. S., Uckun, F. M. (2000). Prognostic Impact of Trisomies of Chromosomes 10, 17, and 5 Among Children With Acute Lymphoblastic Leukemia and High Hyperdiploidy (> 50 Chromosomes). JCO 18: 1876-1887 [Abstract] [Full Text]  
• Michel, G., Landman-Parker, J., Auclerc, M. F., Mathey, C., Leblanc, T., Legall, E., Bordigoni, P., Lamagnere, J. P., Demeocq, F., Perel, Y., Auvrignon, A., Berthou, C., Bauduer, F., Pautard, B., Schneider, P., Schaison, G., Leverger, G., Baruchel, A. (2000). Use of Recombinant Human Granulocyte Colony-Stimulating Factor to Increase Chemotherapy Dose-Intensity: A Randomized Trial in Very High-Risk Childhood Acute Lymphoblastic Leukemia. JCO 18: 1517-1524 [Abstract] [Full Text]  
• Arico, M., Valsecchi, M. G., Camitta, B., Schrappe, M., Chessells, J., Baruchel, A., Gaynon, P., Silverman, L., Janka-Schaub, G., Kamps, W., Pui, C.-H., Masera, G., Conter, V., Riehm, H., Heerema, N., Sallan, S., Pullen, J., Shuster, J., Carroll, A., Raimondi, S., Richards, S. (2000). Outcome of Treatment in Children with Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia. NEJM 342: 998-1006 [Abstract] [Full Text]  
• Cooney, M. J., Bradley, W. G., Symko, S. C., Patel, S. T., Groncy, P. K. (2000). Hypertensive Encephalopathy: Complication in Children Treated for Myeloproliferative Disorders-Report of Three Cases. Radiology 214: 711-716 [Abstract] [Full Text]  
• Eden, O B (2000). Therapeutic trials in childhood ALL: what's their future?. J. Clin. Pathol. 53: 55-59 [Full Text]  
• Felix, C. A., Lange, B. J., Chessells, J. M. (2000). Pediatric Acute Lymphoblastic Leukemia: Challenges and Controversies in 2000. ASH Education Book 2000: 285-302 [Abstract] [Full Text]  
• Heerema, N. A., Nachman, J. B., Sather, H. N., Sensel, M. G., Lee, M. K., Hutchinson, R., Lange, B. J., Steinherz, P. G., Bostrom, B., Gaynon, P. S., Uckun, F. (1999). Hypodiploidy With Less Than 45 Chromosomes Confers Adverse Risk in Childhood Acute Lymphoblastic Leukemia: A Report From the Children's Cancer Group. Blood 94: 4036-4045 [Abstract] [Full Text]  
• Ritchey, A. K., Pollock, B. H., Lauer, S. J., Andejeski, Y., Buchanan, G. R. (1999). Improved Survival of Children With Isolated CNS Relapse of Acute Lymphoblastic Leukemia: A Pediatric Oncology Group Study. JCO 17: 3745-3752 [Abstract] [Full Text]  
• Uckun, F. M., Gaynon, P. S., Stram, D. O., Sensel, M. G., Sarquis, M. B., Lazarus, K. H., Willoughby, M. (1999). Paucity of Leukemic Progenitor Cells in the Bone Marrow of Pediatric B-Lineage Acute Lymphoblastic Leukemia Patients with an Isolated Extramedullary First Relapse. Clin. Cancer Res. 5: 2415-2420 [Abstract] [Full Text]  
• Faderl, S., Estrov, Z., Machida, U., Kami, M., Hirai, H., Cave, H., Suciu, S., Vilmer, E. (1999). Detection of Residual Disease in Childhood Acute Lymphoblastic Leukemia. NEJM 340: 152-154 [Full Text]  
• Donadieu, J., Hill, C., Nachman, J. B., Sather, H. N., Gaynon, P. S. (1998). Augmented Post-Induction Therapy in Childhood Lymphoblastic Leukemia. NEJM 339: 1080-1081 [Full Text]  
• Pui, C.-H., Evans, W. E. (1998). Acute Lymphoblastic Leukemia. NEJM 339: 605-615 [Full Text]