Interfant-99: a treatment protocol for infants under one year with acute lymphoblastic leukaemia
The first international infant leukaemia trial established a hybrid chemotherapy backbone and showed that a late intensification course did not help, while identifying age under six months, KMT2A rearrangement and poor steroid response as the key risk factors.
Overview
International observational study and randomised trial of 482 infants with ALL treated with a hybrid protocol including elements of ALL and AML therapy, with randomisation to a late intensification course or not.
Four-year event-free survival was 47 percent overall with no benefit from late intensification; KMT2A rearrangement, age under six months, high white count and poor prednisone response defined high-risk infants with event-free survival around 20 percent.
- Four-year event-free survival 47 percent overall.
- No benefit from late intensification (hazard ratio 1.07).
Interfant-99 defined the risk groups and backbone used in Interfant-06 and Interfant-21.
- Outcomes remained poor for high-risk infants, motivating later immunotherapy.