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Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome.

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Authors
Oskarsson, Trausti
Söderhäll, Stefan
Arvidson, Johan
Forestier, Erik
Montgomery, Scott
Bottai, Matteo
Lausen, Birgitte
Carlsen, Niels
Hellebostad, Marit
Lähteenmäki, Päivi
Saarinen-Pihkala, Ulla M
G Jónsson, Ólafur
Heyman, Mats
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Issue Date
2016-01

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Haematologica 2016, 101 (1):68-76
Abstract
Relapse is the main reason for treatment failure in childhood acute lymphoblastic leukemia. Despite improvements in the up-front therapy, survival after relapse is still relatively poor, especially for high-risk relapses. The aims of this study were to assess outcomes following acute lymphoblastic leukemia 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. Altogether, 516 of 2735 patients (18.9%) relapsed between 1992 and 2011 and were included in the study. There were no statistically significant differences in outcome between the up-front protocols or between the relapse protocols used, but an improvement over time was observed. The 5-year overall survival for patients relapsing in the period 2002-2011 was 57.5±3.4%, but 44.7±3.2% (P<0.001) if relapse occurred in the period 1992-2001. Factors independently predicting mortality after relapse included short duration of first remission, bone marrow involvement, age ten years or over, 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, the development of novel approaches is urgently needed to increase survival in relapsed childhood acute lymphoblastic leukemia.
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To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.
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http://dx.doi.org/ 10.3324/haematol.2015.131680
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4697893/
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Archived with thanks to Haematologica
ae974a485f413a2113503eed53cd6c53
10.3324/haematol.2015.131680
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