Outcome of children with high-risk acute lymphoblastic leukemia (HR-ALL): Nordic results on an intensive regimen with restricted central nervous system irradiation

Ulla M Saarinen-Pihkala, G Gustafsson, N Carlsen, T Flaegstad, E Forestier, A Glomstein, J Kristinsson, M Lanning, H Schroeder, L Mellander

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Improvement in outcome of childhood high-risk (HR) ALL was sought with a very intensive Nordic protocol leaving most patients without CNS-RT. METHODS: A total of 426 consecutive children entered the NOPHO-92 HR-ALL program. HR criteria included WBC > or =50 x 10(9)/L, CNS or testicular involvement, T-cell, lymphomatous features, t(9;22), t(4;11), or slow response. Of these, 152 children had very high risk (VHR) with special definitions. CNS consolidation was based on high-dose MTX (8 g/m2) and ARA-C (12 g/m2) alternating. VHR patients also received cranial RT. RESULTS: The 9-year EFS was 61 +/- 3%, OS 74 +/- 2%, and EFS for T-ALL 62 +/- 4%. Cumulative incidence of isolated CNS relapse was 4.7 +/- 1%, and CNS relapse in total 9.9 +/- 2%. Poor prognostic factors were WBC > or =200 x 10(9)/L and a very slow response. CONCLUSIONS: HR-ALL was successfully treated on the NOPHO-92 regimen, with a relatively low CNS relapse rate for non-irradiated children. WBC > or =200 x 10(9)/L and very slow response emerged as strong poor prognostic factors.
Original languageEnglish
JournalPediatric Blood & Cancer
DOIs
Publication statusPublished - 1 Jan 2004

Other keywords

  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols
  • Central Nervous System Neoplasms
  • Child
  • Child, Preschool
  • Cohort Studies
  • Combined Modality Therapy
  • Cranial Irradiation
  • Cytarabine
  • Disease-Free Survival
  • Female
  • Humans
  • Infant
  • Male
  • Methotrexate
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Risk Factors
  • Stem Cell Transplantation
  • Transplantation, Homologous
  • Treatment Outcome

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