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document
Comparison of intermittent or continuous methotrexate plus 6-mercaptopurine in regimens for standard-risk acute lymphoblastic leukemia in childhood ( JCCLSG-S811 ) . The Japanese Children 's Cancer and Leukemia Study Group . From 1981 to 1983 , 131 previously untreated patients with acute lymphoblastic leukemia ( ALL ) standard-risk group were entered to the protocol JCCLSG-S811 . Of 119 eligible patients , 115 ( 96.6 % ) attained complete remission by treatment with prednisone ( PRD ) plus vincristine ( VCR ) or vindesine ( VDS ) . After preventive central nervous system ( CNS ) therapy including 18 Gy cranial irradiation and three doses of intrathecal methotrexate ( MTX ) , the patients were assigned randomly to the two maintenance chemotherapies , Regimen A and Regimen B . Regimen A ( intermittent regimen ) consisted of PRD ( 120 mg/m2/day by mouth for 5 days ) plus 6-mercaptopurine ( 6MP ) ( 175 mg/m2/day by mouth for 5 days ) plus VCR ( 2.0 mg/m2 intravenously ) alternating biweekly with MTX ( 225 mg/m2 intravenously ) . Regimen B ( continuous regimen ) consisted of 6MP ( 50 mg/m2/day by mouth ) plus MTX ( 20 mg/m2/week by mouth ) combined with pulses of PRD and VCR ( the same dosages as Regimen A ) every 4 weeks . As the late intensification therapy ( LIT ) , five courses of high-dose MTX ( 2000 mg/m2 per dose per week intravenously for three doses every 12 weeks ) with leucovorin rescue were administered to all patients who were in continuous complete remission ( CCR ) for more than 2 years . Sixty and 55 patients , respectively , were registered in Regimen A and B . The CCR rates in Regimen A and B were 75.1 % +/- 5.8 % ( mean +/- 1 SE ) and 49.7 % +/- 7.3 % ( P less than 0.01 ) at 4 years , and 72.1 % +/- 6.3 % and 49.7 % +/- 7.3 % ( P less than 0.05 ) at 5 years , respectively . In Regimen B , CNS and testicular relapses increased after 3 years of CCR . In addition , the patients in Regimen B had a much higher incidence of infections than Regimen A . The LIT did not seem to have important effects on the duration of CCR . From these data we conclude that the intermittent cyclic regimen of 6MP and MTX may be more effective as compared to the continuous administration of these drugs in the maintenance chemotherapy .
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Intervention_Pharmacological
intermittent or continuous methotrexate
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Intervention_Pharmacological
6-mercaptopurine
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Intervention_Pharmacological
prednisone ( PRD ) plus vincristine ( VCR ) or vindesine ( VDS )
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Intervention_Physical
18 Gy cranial irradiation
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Intervention_Pharmacological
intrathecal methotrexate ( MTX )
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Intervention_Pharmacological
PRD
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Intervention_Pharmacological
plus 6-mercaptopurine ( 6MP )
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Intervention_Pharmacological
plus VCR ( 2.0
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Intervention_Pharmacological
biweekly with MTX
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Intervention_Pharmacological
6MP
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Intervention_Pharmacological
plus MTX
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Intervention_Pharmacological
combined with pulses of PRD and VCR
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Intervention_Pharmacological
MTX
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Intervention_Pharmacological
MTX
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Outcome_Physical
pulses of PRD and VCR
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Outcome_Physical
CCR rates
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Outcome_Physical
CNS and testicular relapses
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Outcome_Adverse-effects
incidence of infections
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Outcome_Physical
duration of CCR
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Participant_Condition
lymphoblastic leukemia
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Participant_Age
childhood
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Participant_Sample-size
119