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Risk group assignment differs for children and adults 1–45 yr with acute lymphoblastic leukemia treated by the NOPHO ALL‐2008 protocol
Author(s) -
Toft Nina,
Birgens Henrik,
Abrahamsson Jonas,
Bernell Per,
Griškevičius Laimonas,
Hallböök Helene,
Heyman Mats,
Holm Mette Skov,
Hulegårdh Erik,
Klausen Tobias Wirenfeldt,
Marquart Hanne V.,
Jónsson Ólafur Gísli,
Nielsen Ove Juul,
QuistPaulsen Petter,
Taskinen Mervi,
Vaitkeviciene Goda,
Vettenranta Kim,
Åsberg Ann,
Schmiegelow Kjeld
Publication year - 2013
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12097
Subject(s) - lymphoblastic leukemia , protocol (science) , leukemia , medicine , pediatrics , oncology , immunology , pathology , alternative medicine
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.