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Leukemia. 2018 Mar;32(3):606-615. doi: 10.1038/leu.2017.265. Epub 2017 Aug 18.

Results of NOPHO ALL2008 treatment for patients aged 1-45 years with acute lymphoblastic leukemia.

Author information

1
Department of Hematology, Herlev University Hospital, University of Copenhagen, Herlev, Denmark.
2
Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark.
3
Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
4
Hematology, Oncology and Transfusion Medicine Center Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania.
5
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
6
Childhood Cancer Research Unit, Karolinska Institute, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
7
Children's Hospital, Landspitali University Hospital, Reykjavík, Iceland.
8
Department of Hematology, North Estonia Medical Centre, Tallinn, Estonia.
9
Tallinn Children's Hospital, Tallinn, Estonia.
10
Department of Hematology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
11
Centre for Pediatric Oncology and Hematology, Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
12
Division of Hematology-Oncology and Stem Cell Transplantation, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
13
Department of Pediatrics, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
14
Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.
15
Department of Clinical Immunology, Section 7631, University Hospital Rigshospitalet, Copenhagen, Denmark.
16
Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
17
Institute Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark.

Abstract

Adults with acute lymphoblastic leukemia (ALL) do worse than children. From 7/2008 to 12/2014, Nordic and Baltic centers treated 1509 consecutive patients aged 1-45 years with Philadelphia chromosome-negative ALL according to the NOPHO ALL2008 without cranial irradiation. Overall, 1022 patients were of age 1-9 years (A), 266 were 10-17 years (B) and 221 were 18-45 years (C). Sixteen patients (three adults) died during induction. All others achieved remission after induction or 1-3 intensive blocks. Subsequently, 45 patients (12 adults) died, 122 patients relapsed (32 adults) with a median time to relapse of 1.6 years and 13 (no adult) developed a second malignancy. Median follow-up time was 4.6 years. Among the three age groups, older patients more often had higher risk ALL due to T-ALL (32%/25%/9%, P<0.001), KMT2A rearrangements (6%/5%/3%, P<0.001) and higher day 29 residual leukemia for B-lineage (P<0.001), but not T-ALL (P=0.53). Event-free survival rates (pEFS5y) were 89±1% (A), 80±3% (B) and 74±4% (C) with significant differences only for non-high risk groups. Except for thrombosis, pancreatitis and osteonecrosis, the risk of 19 specified toxicities was not enhanced by age above 10 years. In conclusion, a pediatric-based protocol is tolerable and effective for young adults, despite their increased frequency of higher risk features.

PMID:
28819280
DOI:
10.1038/leu.2017.265
[Indexed for MEDLINE]

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