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

Författare och institution:
U. M. Saarinen-Pihkala (-); G. Gustafsson (-); N. Carlsen (-); T. Flaegstad (-); E. Forestier (-); A. Glomstein (-); J. Kristinsson (-); M. Lanning (-); H. Schroeder (-); Lotta Mellander (Institutionen för kvinnors och barns hälsa, Avdelningen för pediatrik)
Publicerad i:
Pediatr Blood Cancer, 42 ( 1 ) s. 8-23
1545-5009 (Print)
Artikel, refereegranskad vetenskaplig
Sammanfattning (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.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Adolescent, Antineoplastic Combined Chemotherapy Protocols/administration &, dosage/*therapeutic use, Central Nervous System Neoplasms/*therapy, Child, Child, Preschool, Cohort Studies, Combined Modality Therapy, *Cranial Irradiation, Cytarabine/administration & dosage, Disease-Free Survival, Female, Humans, Infant, Leukemia, Lymphocytic, Acute/*therapy, Male, Methotrexate/administration & dosage, Risk Factors, Stem Cell Transplantation, Transplantation, Homologous, Treatment Outcome
Postens nummer:
Posten skapad:
2007-10-11 15:23

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