Wilejto M, (2015) Pediatr Blood Cancer (Link to abstract)
Retrospective analysis of 19 children aged 1-5 with CNS-positive ALL (precursor B-ALL n=16, T-ALL n=3). These children were treated between 2000 and 2013 at The Hospital for Sick Children in Toronto with different treatment regimens. None of the children were treated with routine Cranial radiation therapy (CRT) although 2 received total body irradiation (TBI) as part of the conditioning regimen for HSCT. When CRT was omitted intensification of systemic and intrathecal therapy was used and was at the discretion of treating physicians (intensification included high dose MTX, triple intrathecal chemotherapy and dexamethasone instead of prednisone). OS was 84.2%, EFS was 79%.
* Although this study has a small number of patients overall and children with T-ALL are under represented, it suggests that at least in children with B-ALL between the ages of 1 and 5, the omission of CRT does not result in inferior outcomes when intensification of systemic therapy and triple ITs are used.