Results of NOPHO ALL2008 treatment for patients aged 1-45 years with acute lymphoblastic leukemia

N Toft; H Birgens; J Abrahamsson; L Griškevičius; H Hallböök; M Heyman; T W Klausen; Ó G Jónsson; K Palk; K Pruunsild; P Quist-Paulsen; G Vaitkeviciene; K Vettenranta; A Åsberg; T L Frandsen; H V Marquart; H O Madsen; U Norén-Nyström; K Schmiegelow

doi:10.1038/leu.2017.265

Results of NOPHO ALL2008 treatment for patients aged 1-45 years with acute lymphoblastic leukemia

N Toft, H Birgens, J Abrahamsson, L Griškevičius, H Hallböök, M Heyman, T W Klausen, Ó G Jónsson, K Palk, K Pruunsild, P Quist-Paulsen, G Vaitkeviciene, K Vettenranta, A Åsberg, T L Frandsen, H V Marquart, H O Madsen, U Norén-Nyström, K Schmiegelow

Institut for Klinisk Medicin

133 Citationer (Scopus)

Abstract

Adults with acute lymphoblastic leukemia (ALL) do worse than children. From 7/2008 to 12/2014, Nordic and Baltic centers treated 1509 consecutive patients aged 1-45 years with Philadelphia chromosome-negative ALL according to the NOPHO ALL2008 without cranial irradiation. Overall, 1022 patients were of age 1-9 years (A), 266 were 10-17 years (B) and 221 were 18-45 years (C). Sixteen patients (three adults) died during induction. All others achieved remission after induction or 1-3 intensive blocks. Subsequently, 45 patients (12 adults) died, 122 patients relapsed (32 adults) with a median time to relapse of 1.6 years and 13 (no adult) developed a second malignancy. Median follow-up time was 4.6 years. Among the three age groups, older patients more often had higher risk ALL due to T-ALL (32%/25%/9%, P<0.001), KMT2A rearrangements (6%/5%/3%, P<0.001) and higher day 29 residual leukemia for B-lineage (P<0.001), but not T-ALL (P=0.53). Event-free survival rates (pEFS5y) were 89±1% (A), 80±3% (B) and 74±4% (C) with significant differences only for non-high risk groups. Except for thrombosis, pancreatitis and osteonecrosis, the risk of 19 specified toxicities was not enhanced by age above 10 years. In conclusion, a pediatric-based protocol is tolerable and effective for young adults, despite their increased frequency of higher risk features.

Originalsprog	Engelsk
Tidsskrift	Leukemia
Vol/bind	32
Sider (fra-til)	606-615
ISSN	0887-6924
DOI	https://doi.org/10.1038/leu.2017.265
Status	Udgivet - 1 mar. 2018

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10.1038/leu.2017.265

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Toft, N., Birgens, H., Abrahamsson, J., Griškevičius, L., Hallböök, H., Heyman, M., Klausen, T. W., Jónsson, Ó. G., Palk, K., Pruunsild, K., Quist-Paulsen, P., Vaitkeviciene, G., Vettenranta, K., Åsberg, A., Frandsen, T. L., Marquart, H. V., Madsen, H. O., Norén-Nyström, U., & Schmiegelow, K. (2018). Results of NOPHO ALL2008 treatment for patients aged 1-45 years with acute lymphoblastic leukemia. Leukemia, 32, 606-615. https://doi.org/10.1038/leu.2017.265

Toft, N, Birgens, H, Abrahamsson, J, Griškevičius, L, Hallböök, H, Heyman, M, Klausen, TW, Jónsson, ÓG, Palk, K, Pruunsild, K, Quist-Paulsen, P, Vaitkeviciene, G, Vettenranta, K, Åsberg, A, Frandsen, TL, Marquart, HV, Madsen, HO, Norén-Nyström, U & Schmiegelow, K 2018, 'Results of NOPHO ALL2008 treatment for patients aged 1-45 years with acute lymphoblastic leukemia', Leukemia, bind 32, s. 606-615. https://doi.org/10.1038/leu.2017.265

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title = "Results of NOPHO ALL2008 treatment for patients aged 1-45 years with acute lymphoblastic leukemia",

abstract = "Adults with acute lymphoblastic leukemia (ALL) do worse than children. From 7/2008 to 12/2014, Nordic and Baltic centers treated 1509 consecutive patients aged 1-45 years with Philadelphia chromosome-negative ALL according to the NOPHO ALL2008 without cranial irradiation. Overall, 1022 patients were of age 1-9 years (A), 266 were 10-17 years (B) and 221 were 18-45 years (C). Sixteen patients (three adults) died during induction. All others achieved remission after induction or 1-3 intensive blocks. Subsequently, 45 patients (12 adults) died, 122 patients relapsed (32 adults) with a median time to relapse of 1.6 years and 13 (no adult) developed a second malignancy. Median follow-up time was 4.6 years. Among the three age groups, older patients more often had higher risk ALL due to T-ALL (32%/25%/9%, P<0.001), KMT2A rearrangements (6%/5%/3%, P<0.001) and higher day 29 residual leukemia for B-lineage (P<0.001), but not T-ALL (P=0.53). Event-free survival rates (pEFS5y) were 89±1% (A), 80±3% (B) and 74±4% (C) with significant differences only for non-high risk groups. Except for thrombosis, pancreatitis and osteonecrosis, the risk of 19 specified toxicities was not enhanced by age above 10 years. In conclusion, a pediatric-based protocol is tolerable and effective for young adults, despite their increased frequency of higher risk features.",

author = "N Toft and H Birgens and J Abrahamsson and L Gri{\v s}kevi{\v c}ius and H Hallb{\"o}{\"o}k and M Heyman and Klausen, {T W} and J{\'o}nsson, {{\'O} G} and K Palk and K Pruunsild and P Quist-Paulsen and G Vaitkeviciene and K Vettenranta and A {\AA}sberg and Frandsen, {T L} and Marquart, {H V} and Madsen, {H O} and U Nor{\'e}n-Nystr{\"o}m and K Schmiegelow",

year = "2018",

month = mar,

day = "1",

doi = "10.1038/leu.2017.265",

language = "English",

volume = "32",

pages = "606--615",

journal = "Leukemia",

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T1 - Results of NOPHO ALL2008 treatment for patients aged 1-45 years with acute lymphoblastic leukemia

AU - Toft, N

AU - Birgens, H

AU - Abrahamsson, J

AU - Griškevičius, L

AU - Hallböök, H

AU - Heyman, M

AU - Klausen, T W

AU - Jónsson, Ó G

AU - Palk, K

AU - Pruunsild, K

AU - Quist-Paulsen, P

AU - Vaitkeviciene, G

AU - Vettenranta, K

AU - Åsberg, A

AU - Frandsen, T L

AU - Marquart, H V

AU - Madsen, H O

AU - Norén-Nyström, U

AU - Schmiegelow, K

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Adults with acute lymphoblastic leukemia (ALL) do worse than children. From 7/2008 to 12/2014, Nordic and Baltic centers treated 1509 consecutive patients aged 1-45 years with Philadelphia chromosome-negative ALL according to the NOPHO ALL2008 without cranial irradiation. Overall, 1022 patients were of age 1-9 years (A), 266 were 10-17 years (B) and 221 were 18-45 years (C). Sixteen patients (three adults) died during induction. All others achieved remission after induction or 1-3 intensive blocks. Subsequently, 45 patients (12 adults) died, 122 patients relapsed (32 adults) with a median time to relapse of 1.6 years and 13 (no adult) developed a second malignancy. Median follow-up time was 4.6 years. Among the three age groups, older patients more often had higher risk ALL due to T-ALL (32%/25%/9%, P<0.001), KMT2A rearrangements (6%/5%/3%, P<0.001) and higher day 29 residual leukemia for B-lineage (P<0.001), but not T-ALL (P=0.53). Event-free survival rates (pEFS5y) were 89±1% (A), 80±3% (B) and 74±4% (C) with significant differences only for non-high risk groups. Except for thrombosis, pancreatitis and osteonecrosis, the risk of 19 specified toxicities was not enhanced by age above 10 years. In conclusion, a pediatric-based protocol is tolerable and effective for young adults, despite their increased frequency of higher risk features.

AB - Adults with acute lymphoblastic leukemia (ALL) do worse than children. From 7/2008 to 12/2014, Nordic and Baltic centers treated 1509 consecutive patients aged 1-45 years with Philadelphia chromosome-negative ALL according to the NOPHO ALL2008 without cranial irradiation. Overall, 1022 patients were of age 1-9 years (A), 266 were 10-17 years (B) and 221 were 18-45 years (C). Sixteen patients (three adults) died during induction. All others achieved remission after induction or 1-3 intensive blocks. Subsequently, 45 patients (12 adults) died, 122 patients relapsed (32 adults) with a median time to relapse of 1.6 years and 13 (no adult) developed a second malignancy. Median follow-up time was 4.6 years. Among the three age groups, older patients more often had higher risk ALL due to T-ALL (32%/25%/9%, P<0.001), KMT2A rearrangements (6%/5%/3%, P<0.001) and higher day 29 residual leukemia for B-lineage (P<0.001), but not T-ALL (P=0.53). Event-free survival rates (pEFS5y) were 89±1% (A), 80±3% (B) and 74±4% (C) with significant differences only for non-high risk groups. Except for thrombosis, pancreatitis and osteonecrosis, the risk of 19 specified toxicities was not enhanced by age above 10 years. In conclusion, a pediatric-based protocol is tolerable and effective for young adults, despite their increased frequency of higher risk features.

U2 - 10.1038/leu.2017.265

DO - 10.1038/leu.2017.265

M3 - Journal article

C2 - 28819280

SN - 0887-6924

VL - 32

SP - 606

EP - 615

JO - Leukemia

JF - Leukemia

ER -

Results of NOPHO ALL2008 treatment for patients aged 1-45 years with acute lymphoblastic leukemia

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