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Outcome of children with high-risk acute lymphoblastic leukemia (HR-ALL): Nordic results on an intensive regimen with restricted central nervous system irradiation

Saarinen-Pihkala, U. M. (author)
Gustafsson, G. (author)
Carlsen, N. (author)
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Flaegstad, T. (author)
Forestier, E. (author)
Glomstein, A. (author)
Kristinsson, J. (author)
Lanning, M. (author)
Schroeder, H. (author)
Mellander, Lotta, 1941 (author)
Gothenburg University,Göteborgs universitet,Institutionen för kvinnors och barns hälsa, Avdelningen för pediatrik,Institute for the Health of Women and Children, Dept of Paediatrics
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 (creator_code:org_t)
2004
2004
English.
In: Pediatr Blood Cancer. - 1545-5009. ; 42:1, s. 8-23
  • Journal article (peer-reviewed)
Abstract Subject headings
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  • BACKGROUND: Improvement in outcome of childhood high-risk (HR) ALL was sought with a very intensive Nordic protocol leaving most patients without CNS-RT. METHODS: A total of 426 consecutive children entered the NOPHO-92 HR-ALL program. HR criteria included WBC > or =50 x 10(9)/L, CNS or testicular involvement, T-cell, lymphomatous features, t(9;22), t(4;11), or slow response. Of these, 152 children had very high risk (VHR) with special definitions. CNS consolidation was based on high-dose MTX (8 g/m2) and ARA-C (12 g/m2) alternating. VHR patients also received cranial RT. RESULTS: The 9-year EFS was 61 +/- 3%, OS 74 +/- 2%, and EFS for T-ALL 62 +/- 4%. Cumulative incidence of isolated CNS relapse was 4.7 +/- 1%, and CNS relapse in total 9.9 +/- 2%. Poor prognostic factors were WBC > or =200 x 10(9)/L and a very slow response. CONCLUSIONS: HR-ALL was successfully treated on the NOPHO-92 regimen, with a relatively low CNS relapse rate for non-irradiated children. WBC > or =200 x 10(9)/L and very slow response emerged as strong poor prognostic factors.

Keyword

Adolescent
dosage/*therapeutic use
Central Nervous System Neoplasms/*therapy
Child
Child
Preschool
Cohort Studies
Combined Modality Therapy
*Cranial Irradiation
Cytarabine/administration & dosage
Disease-Free Survival
Female
Humans
Infant
Leukemia
Lymphocytic
Acute/*therapy
Male
Methotrexate/administration & dosage
Risk Factors
Stem Cell Transplantation
Transplantation
Homologous
Treatment Outcome

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