Relapsed childhood acute lymphoblastic leukemia in the Nordic countries: prognostic factors, treatment and outcome
Trausti Oskarsson,
Stefan Söderhäll,
Johan Arvidson,
Erik Forestier,
Scott Montgomery,
Matteo Bottai,
Birgitte Lausen,
Niels Carlsen,
Marit Hellebostad,
Päivi Lähteenmäki,
Ulla M. Saarinen-Pihkala,
Ólafur G.Jónsson,
Mats Heyman
Affiliations
Trausti Oskarsson
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
Stefan Söderhäll
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
Johan Arvidson
Department of Pediatric Oncology, Uppsala University Hospital, Sweden
Erik Forestier
Department of Pediatrics, Umeå University Hospital, Sweden
Scott Montgomery
Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Sweden;Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden;Department of Epidemiology and Public Health, University College London, UK
Matteo Bottai
Unit of Biostatistics, IMM, Karolinska Institutet, Stockholm, Sweden
Birgitte Lausen
Department of Pediatric Oncology, Rigshospitalet University Hospital, Copenhagen, Denmark
Niels Carlsen
Department of Pediatrics, Odense University Hospital, Denmark
Marit Hellebostad
Department of Pediatrics, Ullevål Hospital, Oslo, Norway
Päivi Lähteenmäki
Department of Pediatrics, Turku University Hospital, Turku, Finland
Ulla M. Saarinen-Pihkala
Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, Finland
Ólafur G.Jónsson
Children’s Hospital, Landspitali University Hospital, Reykjavik, Iceland
Mats Heyman
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
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
