{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T11:15:46Z","timestamp":1792840546836,"version":"4.5.0"},"reference-count":43,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"24","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2010,8,20]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>The adverse prognosis of CD20 expression in adults with de novo precursor B-lineage acute lymphoblastic leukemia (ALL) prompted incorporation of monoclonal antibody therapy with rituximab into the intensive chemotherapy regimen hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone). Other modifications (irrespective of CD20 expression) included early anthracycline intensification, alterations in number of risk-adapted intrathecal chemotherapy treatments for CNS prophylaxis, additional early and late intensifications, and extension of maintenance phase chemotherapy by 6 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>Two hundred eighty-two adolescents and adults with de novo Philadelphia chromosome (Ph)\u2013negative precursor B-lineage ALL were treated with standard or modified hyper-CVAD regimens. The latter incorporated standard-dose rituximab if CD20 expression \u2265 20%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The complete remission (CR) rate was 95% with 3-year rates of CR duration (CRD) and survival (OS) of 60% and 50%, respectively. In the younger (age &lt; 60 years) CD20-positive subset, rates of CRD and OS were superior with the modified hyper-CVAD and rituximab regimens compared with standard hyper-CVAD (70% v 38%; P &lt; .001% and 75% v 47%, P = .003). In contrast, rates of CRD and OS for CD20-negative counterparts treated with modified versus standard hyper-CVAD regimens were similar (72% v 68%, P = not significant [NS] and 64% v 65%, P = NS, respectively). Older patients with CD20-positive ALL did not benefit from rituximab-based chemoimmunotherapy (rates of CRD 45% v 50%, P = NS and OS 28% v 32%, P = NS, respectively), related in part to deaths in CR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The incorporation of rituximab into the hyper-CVAD regimen appears to improve outcome for younger patients with CD20-positive Ph-negative precursor B-lineage ALL.<\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2009.26.9456","type":"journal-article","created":{"date-parts":[[2010,7,27]],"date-time":"2010-07-27T03:49:24Z","timestamp":1280202564000},"page":"3880-3889","source":"Crossref","is-referenced-by-count":367,"title":["Chemoimmunotherapy With a Modified Hyper-CVAD and Rituximab Regimen Improves Outcome in De Novo Philadelphia Chromosome\u2013Negative Precursor B-Lineage Acute Lymphoblastic Leukemia"],"prefix":"10.1200","volume":"28","author":[{"given":"Deborah A.","family":"Thomas","sequence":"first","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"O'Brien","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Faderl","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Garcia-Manero","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Ferrajoli","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Wierda","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhad","family":"Ravandi","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srdan","family":"Verstovsek","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L.","family":"Jorgensen","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Bueso-Ramos","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Andreeff","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherry","family":"Pierce","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Garris","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Keating","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Cortes","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hagop M.","family":"Kantarjian","sequence":"additional","affiliation":[{"name":"From the University of Texas M. D. Anderson Cancer Center, Houston, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.51.5.364"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-07-1254"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-06-2184"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V89.11.3960"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-04-016709"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1990.8.6.994"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.3.547"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20668"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-04-151860"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2009.010306"},{"key":"B11","first-page":"S1","volume":"12","author":"Maloney DG","year":"2001","journal-title":"Anticancer Drugs"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011795"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21776"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.01.1825"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.12.051"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-02-140582"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2003-12-4428"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2400912"},{"key":"B19","first-page":"111","volume-title":"World Health Organization Classification of Tumours","author":"Brunning RD","year":"2001"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2003-08-2958"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2007.1.435"},{"key":"B22","author":"Ravandi F","journal-title":"Blood"},{"key":"B23","first-page":"114","author":"Rytting M","year":"2009","journal-title":"Blood"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-08-043646"},{"key":"B25","author":"Thomas D","journal-title":"Cancer"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2401364"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1309\/AJCP02RPVOKTNWEC"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.3880232"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1958.10501452"},{"key":"B30","first-page":"163","volume":"50","author":"Mantel N","year":"1966","journal-title":"J R Stat Soc"},{"key":"B31","unstructured":"TR Fleming, DP Harrington : Counting Processes and Survival Analysis 1991 New York, NY Wiley"},{"key":"B32","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.2517-6161.1972.tb00899.x","volume":"34","author":"Cox DR","year":"1972","journal-title":"J R Stat Soc"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1986.4.12.1732"},{"key":"B34","first-page":"117","volume":"85","author":"Gokbuget N","year":"2006","journal-title":"Ann Hematol"},{"key":"B35","volume":"94","author":"Hoelzer D","year":"2009","journal-title":"Haematologica"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2009.07.005"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2403559"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-06-164129"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1517\/13543780902832679"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-07-1952"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.13.821"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23890"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V114.22.838.838"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.2009.26.9456","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,23]],"date-time":"2025-02-23T11:36:45Z","timestamp":1740310605000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.2009.26.9456"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,8,20]]},"references-count":43,"journal-issue":{"issue":"24","published-print":{"date-parts":[[2010,8,20]]}},"alternative-id":["10.1200\/JCO.2009.26.9456"],"URL":"https:\/\/doi.org\/10.1200\/jco.2009.26.9456","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,8,20]]}}}