Early Intensification Therapy in High-Risk Childhood Acute Lymphocytic Leukemia: Lack of Benefit from High-Dose Methotrexate

The prognosis for acute lymphoblastic leukemia (ALL) in childhood has improved considerably in the last two decades. Intensive chemotherapy soon after diagnosis has made a major contribution to this success [3, 12, 14], especially in patients with adverse prognostic factors [6]. In COALL-80, a cooperative West German treatment study for ALL, high-risk patients received intensive combination chemotherapy after a modification of the West Berlin protocol BFM 79/81 [7]. In the subsequent study, COALL-82, high-dose methotrexate was added to the intensive phase regimen. The results of both studies, which included 95 high-risk patients, are reported in this paper.