Table 1.
Selected differences between protocols and the comparison of their cure rates.
| Protocol | Genetic Anomalies Characteristic for HR | Drugs Used in Induction | Drugs Used in Consolidation | Drugs Used in Intensification | Maintenance of Remission—Drugs Used and Duration | Radiotherapy | Curability | Reference |
|---|---|---|---|---|---|---|---|---|
| AIEOP BFM ALL 2017 |
KMT2A-AFF1 TCF3-HLF hypodiploidy not ETV6-RUNX1 + any KMT2A rearrangement |
Prednisone VCR DNR Oncaspar MTX i.t. |
Dexamethasone ARA-C VCR Oncaspar CMP 6-MP MTX i.t. |
Dexamethasone VCR DOXO Oncaspar CMP TG MTX i.t. |
MTX p.o. 6-MP MTX i.t (every 6 weeks for HR patients) 74 weeks for boys and girls |
Only for patient with CNS3 status; older than 4 years old | 95% | [10,11] |
| UK ALL 2011 | iAMP21 t(17;19) q(22;p13)//TCF3(E2A)-HLF MLL rearrangement near haploidy hypodiploidy |
Dexamethasone VCR Oncaspar 6-MP MTX i.t. |
6-MP MTX i.t. CMP ARA-C VCR Oncaspar |
Dexamethasone VCR DOXO Oncaspar MTX i.t. CMP ARA-C 6-MP |
4 regimens of maintenance depending on the risk group; dexamethasone VCR 6-MP MTX p.o. MTX i.t. 2 years for girls 3 years for boys |
Only for patient with CNS3 status | 91.5% | [12,13] |
| CCG-ALL-2015 | t (1;19), t (9;22), MLL rearrangement hypodiploidy iAMP21 BCR-ABL fusion E2A-PBX1 fusion |
Dexamethasone (day 1–4) prednisone (day 5–28) VCR DBR Oncaspar CMP ARA-C 6-MP Triple IT = MTX + H-C + ARA-C |
HD-MTX 6-MP |
Dexamethasone VCR DNR ARA-C Oncaspar Triple IT |
6-MP + MTX p.o. + Triple IT every 4 or 7 weeks: dexamethasone VCR CMP ARA-C 76 weeks for boys and girls |
Only for patient with CNS3 status; older than 3 years old |
90% | [14,15] |
| JACLS | t(4;11) or t(1;19) KMT2A/AFF1 hypodiploidy TCF3/PBX1 |
prednisone (day 1–7) Dexamethasone (day 8–14) prednisone (day 15–28) VCR CMP THP-adriamycin Oncaspar MTX i.t. on day 1 Triple IT on day 8.2 |
CMP ARA-C THP-adriamycin 6-MP Triple IT |
Prednisone VCR THP-adriamycin CMP Oncaspar Triple IT |
98 weeks; divided into 4 stages 1A—MTX p.o + 6-MP + Triple IT 1B—MTX p.o. + 6-MP + Triple IT + radiotherapy 2—prednisone + VCR + CMP + Oncaspar 3—MTX p.o + 6-MP + Triple IT 4—prednisone + VCR + THP-adriamycin + Oncaspar |
During maintenance 1B for CNS-positive status | 96.4% | [16] |
| COG-AALL | BCR-ABL fusion transcript t(9;22)(q34;q11) hypodiploid MLL rearrangement |
Dexamethasone VCR Oncaspar MTX i.t. ARA-C i.t. extended induction: DNR |
Dexamethasone VCR 6-MP MTX p.o. MTX i.t. |
Dexamethasone VCR DOXO CMP ARA-C Oncaspar TG MTX i.t. |
Dexamethasone 6-MP MTX p.o. VCR MTX i.t. on day 1 2 years for girls 3 years for boys |
Only for patients with CNS3 status | 95% | [17] |
Comparison of protocols used in ALL treatment. AIEOP BFM ALL 2017—International collaborative treatment protocol for children and adolescents with acute lymphoblastic leukemia, UK ALL 2011—United Kingdom National Randomised Trial For Children and Young Adults with Acute Lymphoblastic Leukaemia and Lymphoma 2011, CCG-ALL-2015—Chinese Children Cancer Group Study, JACLS—Japan Association of Childhood Leukemia Study, COG-AALL—Children Oncology Group Protocol, VCR—Vincristine, DNR—Daunorubicin, DOXO—Doxorubicin, MTX—Methotrexate, ARA-C—Cytarabine, CMP—Cyclophosphamide, TG—Tioguanina, 6-MP—6-Mercaptopurine, H-C—Hydrocortisone, CNS—Central Nervous System p.o.—per os, i.t.—intrathecal.