Comparison of Capizzi and High-dose Methotrexate Approaches in the Treatment of Pediatric B-cell Acute Lymphoblastic Leukemia


Gungoren E. Y., Koc B., ZÜLFİKAR O. B.

Journal of Pediatric Hematology/Oncology, vol.47, no.2, pp.67-73, 2025 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 47 Issue: 2
  • Publication Date: 2025
  • Doi Number: 10.1097/mph.0000000000002995
  • Journal Name: Journal of Pediatric Hematology/Oncology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CAB Abstracts, MEDLINE
  • Page Numbers: pp.67-73
  • Keywords: ALL, B-ALL, capizzi methotrexate, high dose methotrexate
  • Istanbul University Affiliated: Yes

Abstract

Childhood cancers, with leukemia at the forefront, comprise 97% acute leukemia and 3% chronic leukemia, with 75% of acute leukemias being of lymphoblastic origin. Over the past 50 years, survival rates have witnessed a remarkable increase, progressing from around 10% to achieving cure rates exceeding 90% in certain childhood ALL subgroups with the advent of combined therapies. Between 1999 and 2018, a total of 123 patients diagnosed with B-ALL were initially identified, but after applying exclusion criteria, 105 patients were included in the evaluation, who were treated with COG protocols at our center. The mean follow-up duration for patients was determined to be a median of 74 months (min to max: 2 to 228 months). When the cases were evaluated at the end of the study, 59 of 59 individuals in the standard risk group (100%), 21 of 26 individuals in the high-risk group (80.7%), and 14 of 20 individuals in the very high group (70%) were alive. Patients were categorized into 4 groups based on the methotrexate (MTX) doses they received during Phase 3 and Phase 5 of treatment. Event-free survival and overall survival were evaluated among these groups. It was observed that patients in the standard-risk group had significantly higher event-free and overall survival rates. However, no significant difference was found in survival rates when evaluated based on the treatment groups each risk group received by the patients.