Intensive chemotherapy for childhood acute lymphoblastic leukemia: Results of the randomized intercontinental trial ALL IC-BFM 2002

Jan Stary*, Martin Zimmermann, Myriam Campbell, Luis Castillo, Eduardo Dibar, Svetlana Donska, Alejandro Gonzalez, Shai Izraeli, Dragana Janic, Janez Jazbec, Josip Konja, Emilia Kaiserova, Jerzy Kowalczyk, Gabor Kovacs, Chi Kong Li, Edina Magyarosy, Alexander Popa, Batia Stark, Yahia Jabali, Jan TrkaOndrej Hrusak, Hansjörg Riehm, Giuseppe Masera, Martin Schrappe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

259 Scopus citations


Purpose: From 2002 to 2007, the International Berlin-Frankfurt-Münster Study Group conducted a prospective randomized clinical trial (ALL IC-BFM 2002) for the management of childhood acute lymphoblastic leukemia (ALL) in 15 countries on three continents. The aim of this trial was to explore the impact of differential delayed intensification (DI) on outcome in all risk groups. Patients and Methods: For this trial, 5,060 eligible patients were divided into three risk groups according to age, WBC, early treatment response, and unfavorable genetic aberrations. DI was randomized as follows: standard risk (SR), two 4-week intensive elements (protocol III) versus one 7-week protocol II; intermediate risk (IR), protocol III x 3 versus protocol II x 1; high risk (HR), protocol III x 3 versus either protocol II x 2 (Associazione Italiana Ematologia Oncologia Pediatrica [AIEOP] option), or 3 HR blocks plus single protocol II (Berlin-Frankfurt-Münster [BFM] option). Results: At 5 years, the probabilities of event-free survival and survival were 74% (± 1%) and 82% (± 1%) for all 5,060 eligible patients, 81% and 90% for the SR (n = 1,564), 75% and 83% for the IR (n = 2,650), and 55% and 62% for the HR (n = 846) groups, respectively. No improvement was accomplished by more intense and/or prolonged DI. Conclusion: The ALL IC-BFM 2002 trial is a good example of international collaboration in pediatric oncology. A wide platform of countries able to run randomized studies in ALL has been established. Although the alternative DI did not improve outcome compared with standard treatment and the overall results are worse than those achieved by longer established leukemia groups, the national results have generally improved.

Original languageEnglish
Pages (from-to)174-184
Number of pages11
JournalJournal of Clinical Oncology
Issue number3
StatePublished - 20 Jan 2014


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