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

• Published in: Leukemia Vol. 24; no. 2; pp. 397 - 405
• Main Authors: Liang, D-C, Yang, C-P, Lin, D-T, Hung, I-J, Lin, K-H, Chen, J-S, Hsiao, C-C, Chang, T-T, Peng, C-T, Lin, M-T, Chang, T-K, Jaing, T-H, Liu, H-C, Wang, L-Y, Yeh, T-C, Jou, S-T, Lu, M-Y, Cheng, C-N, Sheen, J-M, Chiou, S-S, Wu, K-H, Hung, G-Y, Chen, R-L, Chen, S-H, Cheng, S-N, Chang, Y-H, Chen, B-W, Ho, W-L, Wang, J-L, Lin, S-T, Hsieh, Y-L, Wang, S-C, Chang, H-H, Yang, Y-L, Huang, F-L, Chang, C-Y, Chang, W-H, Lin, K-S
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-02-2010; Nature Publishing Group
• Subjects: Acute lymphoblastic leukemia; Acute lymphocytic leukemia; Adolescent; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Asparaginase; Cancer Research; Care and treatment; Child; Child, Preschool; Children; Chromosome Aberrations; Clinical trials; Combined Modality Therapy; Cranial Irradiation; Critical Care Medicine; Diagnosis; educational-report; Etoposide; Female; Follow-Up Studies; Health aspects; Health risks; Hematology; Humans; Immunophenotyping; Infant; Intensive; Internal Medicine; Irradiation; L-asparaginase; Leukemia; Leukocytes; Lymphatic leukemia; Lymphocytes T; Male; Medicine; Medicine & Public Health; Multivariate analysis; Neoplasm Recurrence, Local - genetics; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasm, Residual; Neoplasms, Second Primary - genetics; Neoplasms, Second Primary - pathology; Neoplasms, Second Primary - therapy; Oncology; Patients; Pediatrics; Precursor Cell Lymphoblastic Leukemia-Lymphoma - genetics; Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prednisolone; Prognosis; Quality of life; Radiation; Remission; Remission Induction; Risk; Risk Factors; Runx1 protein; Skull; Survival Rate; Taiwan; Time Factors; Treatment Outcome; Vincristine; Taiwan; treatment results; acute lymphoblastic leukemia; children
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/leu.2009.248

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.