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Acute Leukemias

Long-term results of the Israeli National Studies in childhood acute lymphoblastic leukemia: INS 84, 89 and 98

Leukemia volume 24, pages 419–424 (2010)Cite this article

By the 1980s, improved results in childhood acute lymphoblastic leukemia (ALL) were achieved with risk-directed combination chemotherapy and central nervous system (CNS) prophylaxis, mostly cranial radiotherapy (CRT). However, concerns about long-term toxicity, neuropsychological and secondary brain tumors prompted our group and others to seek alternative strategies for eliminating preventive CRT (pCRT), in a stepwise increasing proportions of patients.1, 2, 3, 4, 5

Since 1984, we have conducted three Israeli National Studies (INS) of childhood ALL: the INS 84, INS 89 and INS 98.6, 7 In the first study, using a randomized design, we compared the effect of pCRT with extended triple intrathecal therapy (TIT) in the B-lineage ALL low-risk (LR) or standard-risk (SR) groups (25% of total ALL population). In the next two studies, based on the Berlin-Frankfurt-Munster (BFM) backbone, pCRT was omitted in all non-high-risk B- and T-lineage ALL patients (86% of total ALL population). From August 1984 to October 2003, a total of 786 newly diagnosed patients up to 18 years of age were enrolled in these three studies (all were eligible). In all, 181 patients (23%) had T-cell ALL (T-ALL). Four patients were lost to follow-up within the first 5 years from diagnosis, and 10 patients within 10 years. In December 2008, 28, 33 and 74% of event-free survivors in the studies INS 84, INS 89 and INS 98, respectively, had been observed within 12 months.

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Acknowledgements

This work was supported by the Israel Cancer Association. This paper is dedicated to the memory of Professor Rina-Zaizov, the founder of the Israel National Studies for childhood ALL. We thank Professor David Steinberg for his helping with the statistical analysis in earlier years, Vardit Shai and Dina Kugel for data processing and Bella Vakulenko-Lagun and Geffen Kleinstern for the statistical analyses.

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Authors and Affiliations

  1. Center of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    B Stark, G Avrahami & I Yaniv

  2. Department of Statistics, Hebrew University, Jerusalem, Israel

    R Nirel

  3. Department of Pediatric Hematology/Oncology, Shaare Zedek Medical Center, Jerusalem, Israel

    A Abramov

  4. Department of Pediatric Hematology/Oncology, Bnei-Zion Medical Center and Faculty of Medicine, Technion, Haifa, Israel

    D Attias

  5. Department of Pediatric Hematology/Oncology, Edith Wolfson Medical Center, Holon, Israel

    A Ballin

  6. Department of Pediatric Hematology/Oncology Chaim Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    B Bielorai, A Toren & S Izraeli

  7. Department of Pediatric Hematology/Oncology, Dana Children's Hospital, Tel Aviv, Israel

    Y Burstein

  8. Department of Pediatric Hematology/Oncology, Ha-Emek Medical Center, Afula, Israel

    H Gavriel

  9. Department of Pediatric Hematology/Oncology, Rambam Medical Center, and The Bruce Rappaport Faculty of Medicine, Technion-Israel, Institute of Technology, Haifa, Israel

    R Elhasid

  10. Department of Pediatric Hematology/Oncology, Soroka Medical Center, Beer Sheba, Israel

    J Kapelushnik

  11. Department of Pediatric Hematology/Oncology, Kaplan Medical Center, Rehovot, Israel

    D Sthoeger

  12. Department of Pediatric Hematology/Oncology, Hadassah University Hospital, Hebrew University Hadassah Medical School, Jerusalem, Israel

    M Wientraub

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  15. I Yaniv
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  16. S Izraeli
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Correspondence to B Stark.

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Supplementary Information accompanies the paper on the Leukemia website (http://www.nature.com/leu)

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Stark, B., Nirel, R., Avrahami, G. et al. Long-term results of the Israeli National Studies in childhood acute lymphoblastic leukemia: INS 84, 89 and 98. Leukemia 24, 419–424 (2010). https://doi.org/10.1038/leu.2009.254

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