Dose it down: Chemo for acute pediatric leukemia

Clinical Brief – August 4th

The Brief

For kids with a type of leukemia known as acute promyelocytic leukemia (aka APL), it may be possible to use arsenic to help lower their exposure to chemo without sacrificing efficacy.

Believe it or not, arsenic given at the proper dose may be less toxic than full-dose chemo.


Tell me more

Doctors from the Children’s Oncology Group ran a Phase III trial to test the theory that it may be possible to use arsenic instead of a class of chemo known as anthracyclines during a phase of treatment for APL called consolidation.

This trial builds off of the AIDA 0493 trial that had previously shown chemo-based consolidation in a complex treatment regimen can lead to overall survival of about 90%.

Trials in adults have shown that subbing chemo with arsenic did not lead to poorer outcomes. This latest trial was designed to test the same theory in kids with APL.

Here, the event-free survival for standard-risk patients was no worse than that of patients in the AIDA 0493 historical control. But by subbing chemo with arsenic, the overall exposure to chemo therapy can be cut by as much as 50% for standard-risk patients; 36% for high-risk patients.


Bottom line

These findings suggest that it may be possible to some kids with APL to take as little as half the amount of chemo without sacrificing survival. This is thought to lower the risk of chemo-related side effects such as heart damage and infections.

 

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