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document
Oral 6-mercaptopurine versus oral 6-thioguanine and veno-occlusive disease in children with standard-risk acute lymphoblastic leukemia : report of the Children 's Oncology Group CCG-1952 clinical trial . The Children 's Cancer Group 1952 ( CCG-1952 ) clinical trial studied the substitution of oral 6-thioguanine ( TG ) for 6-mercaptopurine ( MP ) and triple intrathecal therapy ( ITT ) for intrathecal methotrexate ( IT-MTX ) in the treatment of standard-risk acute lymphoblastic leukemia . After remission induction , 2027 patients were randomized to receive MP ( n = 1010 ) or TG ( n = 1017 ) and IT-MTX ( n = 1018 ) or ITT ( n = 1009 ) . The results of the thiopurine comparison are as follows . The estimated 7-year event-free survival ( EFS ) for subjects randomized to TG was 84.1 % ( +/- 1.8 % ) and to MP was 79.0 % ( +/- 2.1 % ; P = .004 log rank ) , although overall survival was 91.9 % ( +/- 1.4 % ) and 91.2 % ( +/- 1.5 % ) , respectively ( P = .6 log rank ) . The TG starting dose was reduced from 60 to 50 mg/m ( 2 ) per day after recognition of hepatic veno-occlusive disease ( VOD ) . A total of 257 patients on TG ( 25 % ) developed VOD or disproportionate thrombocytopenia and switched to MP . Once portal hypertension occurred , all subjects on TG were changed to MP . The benefit of randomization to TG over MP , as measured by EFS , was evident primarily in boys who began TG at 60 mg/m ( 2 ) ( relative hazard rate [ RHR ] 0.65 , P = .002 ) . The toxicities of TG preclude its protracted use as given in this study . This study is registered at http : //clinicaltrials.gov as NCT00002744 .
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Intervention_Pharmacological
Oral 6-mercaptopurine
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Intervention_Pharmacological
oral 6-thioguanine
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Intervention_Pharmacological
substitution of oral 6-thioguanine ( TG ) for 6-mercaptopurine ( MP )
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Intervention_Pharmacological
triple intrathecal therapy ( ITT ) for intrathecal methotrexate ( IT-MTX )
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Intervention_Pharmacological
MP
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Intervention_Pharmacological
TG
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Intervention_Pharmacological
IT-MTX
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Intervention_Pharmacological
ITT
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Outcome_Mortality
event-free survival ( EFS )
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Outcome_Mortality
overall survival
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Outcome_Physical
hepatic veno-occlusive disease ( VOD )
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Outcome_Physical
VOD
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Outcome_Physical
disproportionate thrombocytopenia
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Outcome_Physical
portal hypertension
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Participant_Age
children
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Participant_Condition
standard-risk acute lymphoblastic leukemia
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Participant_Age
Children 's
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Participant_Condition
standard-risk acute lymphoblastic leukemia
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Participant_Sample-size
2027
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Participant_Sample-size
257