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. 2020 Feb;34(2):347-357.
doi: 10.1038/s41375-019-0598-2. Epub 2019 Oct 14.

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

P Quist-Paulsen  1 , N Toft  2 , M Heyman  3 , J Abrahamsson  4 , L Griškevičius  5 , H Hallböök  6 , Ó G Jónsson  7 , K Palk  8 , G Vaitkeviciene  9 , K Vettenranta  10 , A Åsberg  11 , T L Frandsen  12 , S Opdahl  13 , H V Marquart  14 , S Siitonen  15 , L T Osnes  16 , M Hultdin  17 , U M Overgaard  18 , U Wartiovaara-Kautto  19 , K Schmiegelow  12   20
Affiliations

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

P Quist-Paulsen et al. Leukemia. 2020 Feb.

Abstract

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.

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