Methods
In the multicenter-trial CoALL08-09, an additional treatment element
consisting of the rarely used chemotherapeutic agent amsacrine combined
with etoposide and methylprednisolone (AEP) (amsacrine 2 x 100
mg/m2, etoposide 2 x 500 mg/m2 and
methylprednisolone 4 x 1000 mg/m2) was implemented
into the first-line treatment of pediatric patients with a poor
treatment response at the end of induction (EOI) measured by minimal
residual disease (MRD). These patients were stratified into a high-risk
intensified arm (HR-I) including an AEP element at the end of
consolidation. Patients with induction failure (IF), i.e. lack of
cytomorphological remission EOI, were eligible for hematopoietic stem
cell transplantation (HSCT) after remission had been reached later on.
These patients received AEP as a part of their MRD-guided
bridging-to-transplant treatment.