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dc.contributor.authorSaarinen-Pihkala, Ulla M
dc.contributor.authorGustafsson, G
dc.contributor.authorCarlsen, N
dc.contributor.authorFlaegstad, T
dc.contributor.authorForestier, E
dc.contributor.authorGlomstein, A
dc.contributor.authorKristinsson, J
dc.contributor.authorLanning, M
dc.contributor.authorSchroeder, H
dc.contributor.authorMellander, L
dc.date.accessioned2010-10-07T14:32:36Z
dc.date.available2010-10-07T14:32:36Z
dc.date.issued2004-01-01
dc.date.submitted2010-10-07
dc.identifier.citationPediatr Blood Cancer. 2004, 42(1):8-23en
dc.identifier.issn1545-5009
dc.identifier.pmid14752789
dc.identifier.doi10.1002/pbc.10461
dc.identifier.urihttp://hdl.handle.net/2336/112624
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractBACKGROUND: 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.
dc.language.isoenen
dc.publisherJohn Wiley & Sons Incen
dc.relation.urlhttp://dx.doi.org/10.1002/pbc.10461en
dc.subject.meshAdolescenten
dc.subject.meshAntineoplastic Combined Chemotherapy Protocolsen
dc.subject.meshCentral Nervous System Neoplasmsen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshCohort Studiesen
dc.subject.meshCombined Modality Therapyen
dc.subject.meshCranial Irradiationen
dc.subject.meshCytarabineen
dc.subject.meshDisease-Free Survivalen
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshMaleen
dc.subject.meshMethotrexateen
dc.subject.meshPrecursor Cell Lymphoblastic Leukemia-Lymphomaen
dc.subject.meshRisk Factorsen
dc.subject.meshStem Cell Transplantationen
dc.subject.meshTransplantation, Homologousen
dc.subject.meshTreatment Outcomeen
dc.titleOutcome of children with high-risk acute lymphoblastic leukemia (HR-ALL): Nordic results on an intensive regimen with restricted central nervous system irradiationen
dc.typeArticleen
dc.contributor.departmentHospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. ulla.pihkala@hus.fien
dc.identifier.journalPediatric blood & canceren
html.description.abstractBACKGROUND: 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.


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