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

• Published in: Leukemia Vol. 34; no. 2; pp. 347 - 357
• Main Authors: Quist-Paulsen, P., Toft, N., Heyman, M., Abrahamsson, J., Griškevičius, L., Hallböök, H., Jónsson, Ó. G., Palk, K., Vaitkeviciene, G., Vettenranta, K., Åsberg, A., Frandsen, T. L., Opdahl, S., Marquart, H. V., Siitonen, S., Osnes, L. T., Hultdin, M., Overgaard, U. M., Wartiovaara-Kautto, U., Schmiegelow, K.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-02-2020; Nature Publishing Group
• Subjects: 631/67/1990/283/2125; 692/699/1541/1990/283/2125; Acute lymphoblastic leukemia; Acute lymphocytic leukemia; Adolescent; Adult; Adults; Age; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Asparaginase; Cancer Research; Care and treatment; Chemotherapy; Child; Child, Preschool; Critical Care Medicine; Denmark; Female; Finland; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Infant; Intensive; Internal Medicine; Leukemia; Lymphatic leukemia; Lymphocytes T; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Methotrexate; Middle Aged; Minimal residual disease; Mortality; Norway; Oncology; Patients; Pediatrics; Pediatrik; Population studies; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma - therapy; Remission; Schedules; Stem cell transplantation; Stem cells; Sweden; T cells; Transplantation; Treatment Outcome; Vincristine; Young Adult; Denmark; Sweden; Norway; Finland
• ISSN: 0887-6924; 1476-5551; 1476-5551
• DOI: 10.1038/s41375-019-0598-2

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.