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Treatment outcome in young adults and children > 10 years of age with acute lymphoblastic leukemia in Sweden: A comparison between a pediatric protocol and an adult protocol
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2006 (English)In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 107, no 7, 1551-1561 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND. Several studies have reported a more favorable outcome for teenagers and young adults with acute lymphoblastic leukemia (ALL) when they were treated in pediatric oncology departments compared with adult hematology departments. However, biased risk grouping and high treatment-related mortality have hampered some of those comparisons. METHODS. In Sweden during the 1990s, adolescents with ALL were treated in a pediatric oncology unit or in an adult hematologic unit, depending on the initial referral. In the current national, comparative, retrospective study, patients with ALL aged 10 years to 40 years who were treated either according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL protocol (1992-2000) (NOPHO-92 protocol) or according to the Swedish Adult ALL Group protocol (1994-2000) (Adult protocol) were included. None of the protocols had age as a high-risk criterion. RESULTS. In total, 243 patients with B-precursor and T-cell ALL were treated according to the protocols. There was a significant difference in the remission rate between the NOPHO-92 protocol (99%; n = 144 patients) and the Adult protocol (90%; n = 99 patients; P <.01), and the event-free survival (EFS) was also superior for the NOPHO-92 protocol compared with the Adult protocol (P <.01). However, EFS was higher for patients aged 15 years to 25 years compared with patients aged 26 years to 40 years within the Adult protocol group (P =.01). The treatment protocol itself was identified as an independent risk factor. CONCLUSIONS. The NOPHO-92 protocol resulted in a better outcome than the Adult protocol; therefore, adolescents may benefit from the pediatric protocol treatment strategy. Prospective trials are warranted to determine whether young adults would benefit from similar treatment.

Place, publisher, year, edition, pages
2006. Vol. 107, no 7, 1551-1561 p.
Keyword [en]
acute lymphoblastic leukemia, treatment outcome, teenager, young adult
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-92961DOI: 10.1002/cncr.22189ISI: 000240909400018PubMedID: 16955505OAI: oai:DiVA.org:uu-92961DiVA: diva2:166294
Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2011-06-10Bibliographically approved
In thesis
1. Acute Lymphoblastic Leukaemia in Adult Patients: Studies of Prognostic Factors, Treatment Results and in vitro Cellular Drug Resistance
Open this publication in new window or tab >>Acute Lymphoblastic Leukaemia in Adult Patients: Studies of Prognostic Factors, Treatment Results and in vitro Cellular Drug Resistance
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Treatment results and clinical characteristics in adult acute lymphoblastic leukaemia (ALL) were evaluated regarding three issues: a new treatment with cytarabine up-front, stem cell transplantation and a comparison between adult and paediatric treatment protocols. All studies were conducted on a national basis. Furthermore, activity of imatinib was investigated by in vitro cytotoxicity assay.

The national protocol was evaluated in 153 adult ALL patients. A high complete remission rate, 86%, was achieved with 29% overall survival at 3-years. Favourable outcome was identified in patients < 40 years with precursor B phenotype and continuous complete remission was higher for precursor B compared to T-ALL.

Stem cell transplantation was evaluated in 187 patients. No differences in outcome between allogeneic and autologous transplantation were found, with the exception of Philadelphia-positive ALL, in which allogeneic transplantation was preferable. Limited chronic graft-versus-host disease (compared to none) resulted in superior disease free survival.

The paediatric NOPHO-92 and the Adult protocols were evaluated for 243 ALL-patients. Superior remission rate and survival were achieved for 10-18 year-olds treated according to the Paediatric protocol compared to both 15-25 and 25-40 year-olds treated according to the Adult protocol. Treatment protocol was a significant prognostic factor for patients aged 15-20 years.

Fluorometric Microculture Cytotoxicity Assey was used to analyze 15 tumour cell samples from ALL patients. High concordance was determined between in vitro sensitivity to imatinib and presence of BCR-ABL. Daunorubicin, prednisolone and cytarabine had the greatest benefit from a combination with imatinib.

The national adult treatment protocol’s results were consistent with international trials regarding precursor B ALL but may be under performing for T-ALL. Adolescents may benefit from treatment according to the Paediatric protocol. No difference in outcome between allogeneic and autologous stem cell transplantation was determined except for Philadelphia-positive patients, despite the indication of a graft-versus-leukaemia effect.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 54 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 30
Keyword
Medicine, acute lymphoblastic leukaemia, adult, adolescent, chemotherapy, stem cell transplantation, in vitro assay, imatinib, Medicin
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:uu:diva-5768 (URN)91-554-6229-4 (ISBN)
Public defence
2005-05-19, Enghoffsalen, Akademiska sjukhuset, Ingång 50, Uppsala, 09:15
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Supervisors
Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2011-06-10Bibliographically approved

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