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In 1962, the total therapy approach to acute lymphocytic leukemia was developed at St. Jude Children's Research Hospital. Briefly, it consists of rapid and efficient induction of complete remission with prednisone and vincristine in order to minimize early attrition, cranial or craniospinal irradiation during the first month of complete remission to prevent meningeal relapse, and multiple-drug chemotherapy for two to three years to eradicate residual systemic leukemia. The objective is cure, not palliation.
In the 1962-1965 pilot studies, 37 of 41 patients entered complete remission; 7 continue in complete remission for seven to nine years and have been off all treatment for four to six years. However, of the 30 relapses, 15 initiated in the meninges, indicating inadequacy of the craniospinal irradiation.
In the 1967-1968 study, the dose of cranial irradiation was increased to 2,400 rads. Of 35 patients entered into this study, 31 developed complete remission. Eighteen survive in
Pinkel D. Total Therapy of Acute Lymphocytic Leukemia. JAMA. 1972;222(9):1170. doi:10.1001/jama.1972.03210090050023