The effect of central nervous system involvement and irradiation in childhood acute lymphoblastic leukemia: Lessons from the NOPHO ALL-92 and ALL-2000 protocols
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The effect of central nervous system involvement and irradiation in childhood acute lymphoblastic leukemia : Lessons from the NOPHO ALL-92 and ALL-2000 protocols. / Taskinen, Mervi; Oskarsson, Trausti; Levinsen, Mette; Bottai, Matteo; Hellebostad, Marit; Jonsson, Olafur Gisli; Lähteenmäki, Päivi; Schmiegelow, Kjeld; Heyman, Mats.
I: Pediatric Blood & Cancer, Bind 64, Nr. 2, 02.2017, s. 242-249.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - The effect of central nervous system involvement and irradiation in childhood acute lymphoblastic leukemia
T2 - Lessons from the NOPHO ALL-92 and ALL-2000 protocols
AU - Taskinen, Mervi
AU - Oskarsson, Trausti
AU - Levinsen, Mette
AU - Bottai, Matteo
AU - Hellebostad, Marit
AU - Jonsson, Olafur Gisli
AU - Lähteenmäki, Päivi
AU - Schmiegelow, Kjeld
AU - Heyman, Mats
N1 - © 2016 Wiley Periodicals, Inc.
PY - 2017/2
Y1 - 2017/2
N2 - BACKGROUND: Central nervous system irradiation (CNS-RT) has played a central role in the cure of acute lymphoblastic leukemia (ALL), but due to the risk of long-term toxicity, it is now considered a less-favorable method of CNS-directed therapy.PROCEDURES: Retrospectively, we estimated the effect of CNS involvement and CNS-RT on events and overall survival (OS) in 835 children treated for high-risk ALL in the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL-92 and ALL-2000 trials.RESULTS: We did not observe a statistically significant difference in the OS or event-free survival (EFS) in patients with CNS involvement at diagnosis, but the risk of isolated CNS relapse was higher (hazard ratio [HR] 7.09, P < 0.001). CNS-RT was given to 169 of the 783 patients in first complete remission, of which 16 had CNS involvement at diagnosis. In general, CNS-RT improved EFS (HR 0.58, P < 0.05) but not OS (HR 0.69, P = n.s.). The adjusted HRs for all relapses, isolated bone marrow relapse, CNS-involving relapse, and isolated CNS relapse, were 0.47 (P < 0.01), 0.50 (P < 0.05), 0.34 (P < 0.01), and 0.12 (P < 0.01), respectively, in irradiated patients.CONCLUSIONS: CNS-RT was associated with an advantage in EFS by decreasing the risk of relapse but without improving OS.
AB - BACKGROUND: Central nervous system irradiation (CNS-RT) has played a central role in the cure of acute lymphoblastic leukemia (ALL), but due to the risk of long-term toxicity, it is now considered a less-favorable method of CNS-directed therapy.PROCEDURES: Retrospectively, we estimated the effect of CNS involvement and CNS-RT on events and overall survival (OS) in 835 children treated for high-risk ALL in the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL-92 and ALL-2000 trials.RESULTS: We did not observe a statistically significant difference in the OS or event-free survival (EFS) in patients with CNS involvement at diagnosis, but the risk of isolated CNS relapse was higher (hazard ratio [HR] 7.09, P < 0.001). CNS-RT was given to 169 of the 783 patients in first complete remission, of which 16 had CNS involvement at diagnosis. In general, CNS-RT improved EFS (HR 0.58, P < 0.05) but not OS (HR 0.69, P = n.s.). The adjusted HRs for all relapses, isolated bone marrow relapse, CNS-involving relapse, and isolated CNS relapse, were 0.47 (P < 0.01), 0.50 (P < 0.05), 0.34 (P < 0.01), and 0.12 (P < 0.01), respectively, in irradiated patients.CONCLUSIONS: CNS-RT was associated with an advantage in EFS by decreasing the risk of relapse but without improving OS.
KW - Adolescent
KW - Central Nervous System Neoplasms/etiology
KW - Child
KW - Child, Preschool
KW - Combined Modality Therapy
KW - Cranial Irradiation
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Infant
KW - Male
KW - Neoplasm Recurrence, Local/etiology
KW - Neoplasm Staging
KW - Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications
KW - Prognosis
KW - Retrospective Studies
KW - Survival Rate
U2 - 10.1002/pbc.26191
DO - 10.1002/pbc.26191
M3 - Journal article
C2 - 27748030
VL - 64
SP - 242
EP - 249
JO - Pediatric Blood & Cancer
JF - Pediatric Blood & Cancer
SN - 1545-5009
IS - 2
ER -
ID: 195153992