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Acute lymphoblastic leukemia

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

Leukemia volume 34, pages 347–357 (2020)Cite this article

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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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Acknowledgements

We thank all patients involved and clinicians assisting in ALL treatment and data collection.

Author information

Authors and Affiliations

  1. Department of Hematology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway

    P. Quist-Paulsen

  2. Department of Hematology, Herlev University Hospital, University of Copenhagen, Herlev, Denmark

    N. Toft

  3. Childhood Cancer Research Unit, Karolinska Institute, Astrid Lindgren’s Childrens’ Hospital, Karolinska University Hospital, Stockholm, Sweden

    M. Heyman

  4. Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    J. Abrahamsson

  5. Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania

    L. Griškevičius

  6. Department of Medical Sciences, Uppsala University, Uppsala, Sweden

    H. Hallböök

  7. Children’s Hospital, Landspitali University Hospital, Reykjavík, Iceland

    Ó. G. Jónsson

  8. Department of Hematology, North Estonia Medical Centre, Tallinn, Estonia

    K. Palk

  9. Centre for Pediatric Oncology and Hematology, Children’s Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius University, Vilnius, Lithuania

    G. Vaitkeviciene

  10. Division of Hematology-Oncology and Stem Cell Transplantation, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland

    K. Vettenranta

  11. Department of Pediatrics, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway

    A. Åsberg

  12. Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark

    T. L. Frandsen & K. Schmiegelow

  13. Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU, Trondheim, Norway

    S. Opdahl

  14. Department of Clinical Immunology, Section 7631, University Hospital Rigshospitalet, Copenhagen, Denmark

    H. V. Marquart

  15. Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland

    S. Siitonen

  16. Department of Immunology, Oslo University Hospital, Oslo, Norway

    L. T. Osnes

  17. Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden

    M. Hultdin

  18. Department of Hematology, The University Hospital Rigshospitalet, Copenhagen, Denmark

    U. M. Overgaard

  19. Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland

    U. Wartiovaara-Kautto

  20. Institute Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark

    K. Schmiegelow

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  1. P. Quist-Paulsen
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Quist-Paulsen, P., Toft, N., Heyman, M. et al. T-cell acute lymphoblastic leukemia in patients 1–45 years treated with the pediatric NOPHO ALL2008 protocol. Leukemia 34, 347–357 (2020). https://doi.org/10.1038/s41375-019-0598-2

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