Risk group assignment differs for children and adults 1-45 yr with acute lymphoblastic leukemia treated by the NOPHO ALL-2008 protocol

Nina Toft, Henrik Birgens, Jonas Abrahamsson, Per Bernell, Laimonas Griškevi?ius, Helene Hallböök, Mats Heyman, Mette Skov Holm, Erik Hulegårdh, Tobias Wirenfeldt Klausen, Hanne V Marquart, Olafur Gísli Jónsson, Ove Juul Nielsen, Petter Quist-Paulsen, Mervi Taskinen, Goda Vaitkeviciene, Kim Vettenranta, Ann Åsberg, Kjeld Schmiegelow

93 Citations (Scopus)

Abstract

Background: The prognosis of acute lymphoblastic leukemia is poorer in adults than in children. Studies have indicated that young adults benefit from pediatric treatment, although no upper age limit has been defined. Design and methods: We analyzed 749 patients aged 1-45 yr treated by the NOPHO ALL-2008 protocol. Minimal residual disease (MRD) on days 29 and 79, immunophenotype, white blood cell count (WBC), and cytogenetics were used to stratify patients to standard-, intermediate-, or high-risk treatment with or without hematopoietic stem cell transplantation. Results: Adults aged 18-45 had significantly lower WBCs at diagnosis compared with children aged 1-9 and 10-17 yr, but significantly more adults were stratified to high-risk chemotherapy (8%, 14%, 17%; P < 0.0001) or high-risk chemotherapy with transplantation (4%, 13%, 19%; P < 0.0001). This age-dependent skewing of risk grouping reflected more T-ALL (11%, 27%, 33%, P < 0.0001), poorer MRD response day 29 (MRD < 0.1%: 75%, 61%, 52%; P < 0.0001), and more MLL gene rearrangements (3%, 3%, 10%; P = 0.005) in older patients. Conclusions: Even if identical diagnostics, treatment, and risk stratification are implemented, more adults will be stratified to high-risk therapy, which should be considered when comparing pediatric and adult outcomes.

Original languageEnglish
JournalEuropean Journal of Haematology
Volume90
Issue number5
Pages (from-to)404-412
Number of pages9
ISSN0902-4441
DOIs
Publication statusPublished - May 2013

Fingerprint

Dive into the research topics of 'Risk group assignment differs for children and adults 1-45 yr with acute lymphoblastic leukemia treated by the NOPHO ALL-2008 protocol'. Together they form a unique fingerprint.

Cite this