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Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome
Department of Pediatric Oncology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden; Childhood Cancer Research Unit, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
Department of Pediatric Oncology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden; Childhood Cancer Research Unit, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
Department of Pediatric Oncology, Uppsala University Hospital, Sweden.
Department of Pediatrics, Umeå University Hospital, Sweden.
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2016 (English)In: Haematologica, ISSN 0390-6078, E-ISSN 1592-8721, Vol. 101, no 1, 68-76 p.Article in journal (Refereed) Published
Abstract [en]

Relapse is the main reason for treatment failure in childhood acute lymphoblastic leukemia. Despite improvements in the upfront therapy, survival after relapse is still relatively poor, especially for high-risk relapses. The aims of this study were to assess outcomes following ALL relapse after common initial Nordic Society of Paediatric Haematology and Oncology protocol treatment; to validate currently used risk stratifications; and identify additional prognostic factors for overall survival. In total 516 of 2735 patients (18.9%) relapsed between 1992 and 2011 and were included. There were no statistically significant differences in outcome between the upfront protocols or between the relapse-protocols used, but an improvement over time was observed. The 5-year overall survival for patients relapsing 2002-2011 was 57.5 +/- 3.4% but 44.7 +/- 3.2% (p<0.001) if relapse occurred 1992-2001. Factors independently predicting mortality after relapse included short duration of first remission, bone marrow involvement, age ≥10 years, unfavorable cytogenetics and Down syndrome. T-cell immunophenotype was not an independent prognostic factor unless in combination with hyperleukocytosis at diagnosis. The outcome for early combined pre-B relapses was unexpectedly poor (5-year overall survival 38.0 +/- 10.6%) which supports the notion that these patients need further risk adjustment. Although survival outcomes have improved over time, development of novel approaches is urgent to increase survival in relapsed childhood acute lymphoblastic leukemia.

Place, publisher, year, edition, pages
Pavia, Italy: Ferrata Storti Foundation, 2016. Vol. 101, no 1, 68-76 p.
National Category
Hematology
Identifiers
URN: urn:nbn:se:oru:diva-47189DOI: 10.3324/haematol.2015.131680ISI: 000371220700021PubMedID: 26494838Scopus ID: 2-s2.0-84952940670OAI: oai:DiVA.org:oru-47189DiVA: diva2:888096
Funder
Swedish Childhood Cancer Foundation
Available from: 2015-12-22 Created: 2015-12-22 Last updated: 2016-03-29Bibliographically approved

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CiteExportLink to record
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