{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:50:31Z","timestamp":1785408631602,"version":"3.56.0"},"reference-count":36,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"14","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2021,5,10]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p> Children's Oncology Group (COG) AALL0331 tested whether pegaspargase intensification on a low-intensity chemotherapy backbone would improve the continuous complete remission (CCR) rate in a low-risk subset of children with standard-risk B-acute lymphoblastic leukemia (ALL). <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p> AALL0331 enrolled 5,377 patients with National Cancer Institute standard-risk B-ALL (age 1-9 years, WBC &lt; 50,000\/\u03bcL) between 2005 and 2010. Following a common three-drug induction, a cohort of 1,857 eligible patients participated in the low-risk ALL random assignment. Low-risk criteria included no extramedullary disease, &lt; 5% marrow blasts by day 15, end-induction marrow minimal residual disease &lt; 0.1%, and favorable cytogenetics ( ETV6-RUNX1 fusion or simultaneous trisomies of chromosomes 4, 10, and 17). Random assignment was to standard COG low-intensity therapy (including two pegaspargase doses, one each during induction and delayed intensification) with or without four additional pegaspargase doses at 3-week intervals during consolidation and interim maintenance. The study was powered to detect a 4% improvement in 6-year CCR rate from 92% to 96%. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p> The 6-year CCR and overall survival (OS) rates for the entire low-risk cohort were 94.7% \u00b1 0.6% and 98.7% \u00b1 0.3%, respectively. The CCR rates were similar between arms (intensified pegaspargase 95.3% \u00b1 0.8% v standard 94.0% \u00b1 0.8%; P = .13) with no difference in OS (98.1% \u00b1 0.5% v 99.2% \u00b1 0.3%; P = .99). Compared to a subset of standard-risk study patients given identical therapy who had the same early response characteristics but did not have favorable or unfavorable cytogenetics, outcomes were significantly superior for low-risk patients (CCR hazard ratio 1.95; P = .0004; OS hazard ratio 5.42; P &lt; .0001). <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p> Standard COG therapy without intensified pegaspargase, which can easily be given as an outpatient with limited toxicity, cures nearly all children with B-ALL identified as low-risk by clinical, early response, and favorable cytogenetic criteria. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.20.02370","type":"journal-article","created":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T19:59:28Z","timestamp":1616183968000},"page":"1540-1552","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":46,"title":["Favorable Trisomies and <i>ETV6-RUNX1<\/i> Predict Cure in Low-Risk B-Cell Acute Lymphoblastic Leukemia: Results From Children's Oncology Group Trial AALL0331"],"prefix":"10.1200","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8409-0589","authenticated-orcid":false,"suffix":"Jr","given":"Leonard A.","family":"Mattano","sequence":"first","affiliation":[{"name":"HARP Pharma Consulting, Mystic, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1099-3478","authenticated-orcid":false,"given":"Meenakshi","family":"Devidas","sequence":"additional","affiliation":[{"name":"Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3711-9529","authenticated-orcid":false,"given":"Kelly W.","family":"Maloney","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, 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