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T-cell acute lymphoblastic leukemia in patients 1-45 years treated with the pediatric NOPHO ALL2008 protocol.

Journal article
Authors P Quist-Paulsen
N Toft
M Heyman
Jonas Abrahamsson
L Griškevičius
H Hallböök
Ó G Jónsson
K Palk
G Vaitkeviciene
K Vettenranta
A Åsberg
T L Frandsen
S Opdahl
H V Marquart
S Siitonen
L T Osnes
M Hultdin
U M Overgaard
U Wartiovaara-Kautto
K Schmiegelow
Published in Leukemia
Volume 34
Issue 2
Pages 347-57
ISSN 1476-5551
Publication year 2020
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 347-57
Language en
Links dx.doi.org/10.1038/s41375-019-0598-...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Pediatrics

Abstract

The NOPHO ALL2008 is a population-based study using an unmodified pediatric protocol in patients 1-45 years of age with acute lymphoblastic leukemia. Patients with T-ALL were given a traditional pediatric scheme if fast responding (minimal residual disease (MRD) < 0.1% day 29), or intensive block-based chemotherapy if slow responding (MRD > 0.1% day 29). Both treatment arms included pediatric doses of high-dose methotrexate and asparaginase. If MRD ≥ 5% on day 29 or ≥0.1% after consolidation, patients were assigned to allogeneic hematopoietic stem cell transplantation. The 5-year overall survival of the 278 T-ALL patients was 0.75 (95% CI 0.69-0.81), being 0.82 (0.74-0.88) for patients 1.0-9.9 years, 0.76 (0.66-0.86) for those 10.0-17.9 years, and 0.65 (0.55-0.75) for the older patients. The risk of death in first remission was significantly higher in adults (12%) compared with the 1-9 years group (4%). The MRD responses in the three age groups were similar, and only a nonsignificant increase in relapse risk was found in adults. In conclusion, an unmodified pediatric protocol in patients 1-45 years is effective in all age groups. The traditional pediatric treatment schedule was safe for all patients, but the intensive block therapy led to a high toxic death rate in adults.

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