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Acute Leukemias

Long-term results of Taiwan Pediatric Oncology Group studies 1997 and 2002 for childhood acute lymphoblastic leukemia

Leukemia volume 24, pages 397–405 (2010)Cite this article

Abstract

The long-term outcome of 1390 children with acute lymphoblastic leukemia (ALL), treated in two successive clinical trials (Taiwan Pediatric Oncology Group (TPOG)-ALL-97 and TPOG-ALL-2002) between 1997 and 2007, is reported. The event-free survival improved significantly (P=0.0004) over this period, 69.3±1.9% in 1997–2001 to 77.4±1.7% in 2002–2007. A randomized trial in TPOG-97 testing L-asparaginase versus epidoxorubicin in combination with vincristine and prednisolone for remission induction in standard-risk (SR; low-risk) patients yielded similar outcomes. Another randomized trial, in TPOG-2002, showed that for SR patients, two reinduction courses did not improve long-term outcome over one course. Decreasing use of prophylactic cranial irradiation in the period 1997–2008 was not associated with increased rates of CNS relapse, prompting complete omission of prophylactic cranial irradiation from TPOG protocols, beginning in 2009. Decreased use of etoposide and cranial irradiation likely contributed to the low incidence of second cancers. High-risk B-lineage ALL, T-cell, CD10 negativity, t(9;22), infant, and higher leukocyte count were consistently adverse factors, whereas hyperdiploidy >50 was a consistently favorable factor. Higher leukocyte count and t(9;22) retained prognostic significance in both TPOG-97 and TPOG-2002 by multivariate analysis. Although long-term outcome in TPOG clinical trials is comparable with results being reported worldwide, the persistent strength of certain prognostic variables and the lower frequencies of favorable outcome predictors, such as ETV6-RUNX1 and hyperdiploidy >50, in Taiwanese children warrant renewed effort to cure a higher proportion of patients while preserving their quality of life.

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Acknowledgements

We thank Ching-Hon Pui, MD, St Jude Children's Research Hospital, Memphis, USA, for his supervision in protocol design, critical comments, and continuous support. We are also grateful to the Data Managers of the Biostatistics Department, the Childhood Cancer Foundation, Taiwan: Ms Hsiu-E Hsu, Hsiu-Chuan Lin, Shiow-Lian Wang, and Pi-Ju Wu for their assistance. This work was supported by the Childhood Cancer Foundation of the ROC, Taipei, Taiwan.

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Authors and Affiliations

  1. Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC

    D-C Liang, H-C Liu, L-Y Wang & T-C Yeh

  2. Department of Hematology–Oncology, Chang Gung Children's Hospital–Linkou, Taoyuan, Taiwan, ROC

    C-P Yang, I-J Hung & T-H Jaing

  3. Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, ROC

    D-T Lin, K-H Lin, S-T Jou, M-Y Lu, H-H Chang, Y-L Yang & K-S Lin

  4. Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan, ROC

    J-S Chen & C-N Cheng

  5. Department of Pediatrics, Chang Gung Children's Hospital–Kaohsiung, Kaohsiung, Taiwan, ROC

    C-C Hsiao & J-M Sheen

  6. Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC

    T-T Chang & S-S Chiou

  7. Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan, ROC

    C-T Peng & K-H Wu

  8. Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan, ROC

    M-T Lin & S-C Wang

  9. Department of Pediatrics, Veterans General Hospital–Taichung, Taichung, Taiwan, ROC

    T-K Chang & F-L Huang

  10. Department of Pediatrics, Veterans General Hospital-Taipei, Taipei, Taiwan, ROC

    G-Y Hung

  11. Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan, ROC

    R-L Chen

  12. Department of Pediatrics, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan, ROC

    S-H Chen

  13. Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan, ROC

    S-N Cheng

  14. Department of Pediatrics, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan, ROC

    Y-H Chang

  15. Department of Pediatrics, Koo Foundation Sun-Yat-Sen Cancer Center, Taipei, Taiwan, ROC

    B-W Chen

  16. Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC

    W-L Ho

  17. Department of Pediatrics, Wanfang Hospital Taipei Medical University, Taipei, Taiwan, ROC

    J-L Wang

  18. Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan, ROC

    S-T Lin & C-Y Chang

  19. Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan, ROC

    Y-L Hsieh

  20. Childhood Cancer Foundation of the ROC, Taipei, Taiwan, ROC

    W-H Chang & K-S Lin

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Correspondence to K-S Lin.

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Liang, DC., Yang, CP., Lin, DT. et al. Long-term results of Taiwan Pediatric Oncology Group studies 1997 and 2002 for childhood acute lymphoblastic leukemia. Leukemia 24, 397–405 (2010). https://doi.org/10.1038/leu.2009.248

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