Treatment Outcomes of Acute Lymphoblastic Leukemia in both children and adults using the Thai Pediatric Oncology Group-based protocol at Chiang Mai University hospital
Keywords:
Acute lymphoblastic leukemia, Chiang Mai Cancer Registry, outcomes, ThaiPOGAbstract
Backgrounds: Acute lymphoblastic leukemia (ALL) occurs in both children and adults. It is the most common type of cancer in children and its prognosis is not optimistic in adults. According to the advent of effective ALL therapy, long-term survival rates and cured rates could be more than 80%. However, that in Thailand between 1995 and 2009 ranged from 51–59%. Objective: This study analyses the outcomes of the National Health Security Office (NHSO) ALL national protocols in Thai children and adults, using data collected from the Chiang Mai Cancer Registry, Faculty of Medicine, Chiang Mai University. Materials and methods: Participants were 83 children and 54 adult patients with ALL between 2005 and 2012. The newly-diagnosed high-risk patients might have been received prophylactic cranial irradiation (PCI). The demographic, clinical characteristics, treatment outcomes, incidence and site of relapse were analyzed using descriptive statistics. The analyses were separated into two parts between children and adults ALL patients: estimated disease-free survival (DSF) and the relapse rates using Kaplan-Meier method and compared the relapse rates in adults using log-rank test. Results: The five-year overall survival rate for children was 59.04% (45.65% in the high-risk and 70.27% in the standard-risk groups) and for those who relapsed was 21.69% (26.09% and 12.22%, respectively). The five-year DFS rates were 62.6% and 81.2% in the high-risk and standard-risk groups, respectively. In adults, the five-year survival rate was 25.93% and it was 46.30% in those who relapsed, and the five-year DFS rate was 36.2%. The most relapses occurred in central nervous system (CNS). Conclusion: The standard national protocols for ALL could not improve the outcomes. The relapse occurrence of ALL was still quite common in both children and adults. PCI has been shown a slightly better outcome in terms of prevention or delayed CNS relapse.
References
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Fullmer A, O’Brien S, Kantarjian H, Jabbour E. Novel Therapies for Relapsed Acute Lymphoblastic Leukemia. Curr Hematol Malig Rep. 2009; 4: 148–156.
Joyce M, Pollock BH, Devidas M, Buchanan G, Camitta B. Chemotherapy for Initial Induction Failures in Children Acute Lymphoblastic Leukemia: a Children’s Oncology Group Study (POG 8764). J Pediatr Hematol Oncol. 2013; 35:32–35.
Lee JW, Cho B. Prognostic factors and treatment of children acute lymphoblastic leukemia. Korean J Pediatr. 2017; 60:129–137.
Terwilliger T, Abdul-Hay M. Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood Cancer J. 2017; 7:e577.
Schrappe M, Reiter A, Ludwig WD, Harbott J, Zimmermann M, Hiddemann W, et al. Improved outcome in children acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: results of trial ALL-BFM 90. German-Austrian-Swiss ALL-BFM Study Group. Blood. 2000; 95: 3310-3322.
Silverman LB, Gelber RD, Dalton VK, Asselin BL, Barr RD, Clavell LA, et al. Improved outcome for children with acute lymphoblastic leukemia: results of Dana-Farber Consortium Protocol 91-01. Blood. 2001; 97: 1211-1218.
Pui CH, Evans WE. Treatment of acute lymphoblastic leukemia. N Engl J Med. 2006; 354:166–178.
Stock W, La M, Sanford B, Bloomfield CD, Vardiman JW, Gaynon P, et al. What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children’s Cancer Group and Cancer and Leukemia Group B studies. Blood. 2008; 112: 1646–1654.
Hoelzer D, Thiel E, Loffler H, Büchner T, Ganser A, Heil G, et al. Prognostic factors in a multicenter study for treatment of acute lymphblastic leukemia in adults. Blood. 1988; 71:123-131.
Goldstone AH, Richards SM, Lazarus HM, Tallman MS, Buck G, Fielding AK, et al. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood journal. 2008; 111:1827-1833.
Pulte D, Redaniel MT, Jansen L, Brenner H, Jeffreys M. Recent trends in survival of adult patients with acute leukemia: overall improvements, but persistent and partly increasing disparity in survival of patients from minority groups. Haematologica. 2013; 98: 222–229.
Oriol A, Vives S, Hernández-Rivas JM, Tormo M, Heras I, Rivas C, et al. Outcome after relapse of acute lymphoblastic leukemia in adult patients included in four consecutive risk-adapted trials by the PETHEMA Study Group. Haematologica. 2010; 95: 589–596.
Locatelli F, Schrappe M, Bernardo ME, Rutella S. How I treat relapsed children acute lymphoblastic leukemia. Blood journal. 2012; 120: 2807-2816.
Cancela CS, Murao M, Viana MB, de Oliveira BM. Incidence and risk factors for central nervous system relapse in children and adolescents with acute lymphoblastic leukemia.Rev Bras Hematol Hemoter. 2012; 34: 436–441.
Thai Pediatric Oncology Group. Practical guidelines: Leukemia in children. Bangkok, National Health Security Office (NHSO). [Online]. 2006 [cited 2018 Mar 30], Available from: https://www.nhso.go.th/frontend/page-forhospital_cpg.aspx
Conter V, Schrappe M, Aricó M, Reiter A, Rizzari C, Dördelmann M, et al. Role of cranial radiotherapy for children T-cell acute lymphoblastic leukemia with high WBC count and good response to prednisone. Associazione Italiana Ematologia Oncologia Childrena and the Berlin-Frankfurt-Münster groups. J Clin Oncol. 1997; 15:2786-91.
Hata M, Ogino I, Aida N, Saito K, Omura M, Kigasawa H, et al. Prophylactic cranial irradiation of acute lymphoblastic leukemia in children: outcomes of late effects on pituitary function and growth in long-term survivors. Int J Cancer. 2001; 96 Suppl: 117-124.
Giordano FA, Welzel G, Abo-Madyan Y, Wenz F. Potential toxicities of prophylactic cranial irradiation. Transl Lung Cancer Res. 2012; 1: 254–262.
Meshref MM, Elshazly N, Nasr M, Abdelhai R. Effect of prophylactic cranial irradiation dose on CNS relapse, late cognitive decline and learning disabilities in children treated for acute lymphoblastic leukemia. J Clin Oncol. 2006 24:18_suppl, 9032-9032.
Waber DP, Turek J, Catania L, Stevenson K, Robaey P, Romero I, et al. Neuropsychological outcomes from a randomized trial of triple intrathecal chemotherapy compared with 18 Gy cranial radiation as NS treatment in acute lymphoblastic leukemia: findings from Dana-Farber Cancer Institute ALL Consortium Protocol 95-01. J Clin Oncol. 2007; 25:4914-21.
Chemaitilly W, Li Z, Huang S, Ness KK, Clark KL, Green DM, et al. Anterior hypopituitarism in adult survivors of children cancers treated with cranial radiotherapy: a report from the St Jude Lifetime Cohort study. J Clin Oncol. 2015; 33: 492-500.
Löning L, Zimmermann M, Reiter A, Kaatsch P, Henze G, Riehm H, et al. Secondary neoplasms subsequent to Berlin-Frankfurt-Münster therapy of acute lymphoblastic leukemia in children: significantly lower risk without cranial radiotherapy. Blood. 2000; 95:2770-5.
Pui CH, Cheng C, Leung W, Rai SN, Rivera GK, Sandlund JT, et al. Extended follow-up of long-term survivors of children acute lymphoblastic leukemia. N Engl J Med. 2003; 349:640-649.
Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25676887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015; 385:977-1010.
Hunger SP, Lu X, Devidas M, Camitta BM, Gaynon PS, Winick NJ, et al. Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the children’s oncology group. J Clin Oncol. 2012; 30: 1663-9.
Seksarn P, Wiangnon S , Veerakul G, Chotsampancharoen T, Kanjanapongkul S, Chainansamit S. Outcome of Children Acute Lymphoblastic Leukemia Treated Using the Thai National Protocols. Asian Pac J Cancer Prev. 2015:16, 4609-4614.
Hallböök H, Gustafsson G, Smedmyr B, Söderhäll S, Heyman M; Swedish Adult Acute Lymphocytic Leukemia Group. Treatment outcome in young adults and children >10 years of age with acute lymphoblastic leukemia in Sweden: a comparison between a pediatric protocol and an adult protocol. cancer. 2006; 107:1551-61.
Jaime-Pérez JC, Jiménez-Castillo RA, Herrera-Garza JL, Gutiérrez-Aguirre H, Marfil-Rivera LJ, Gómez-Almaguer D. Survival Rates of Adults with Acute Lymphoblastic Leukemia in a Low-Income Population: A Decade of Experience at a Single Institution in Mexico. Clin Lymphoma Myeloma Leuk. 2017; 17:60-68.
Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of medicine, Chiang Mai University, Chiang Mai, Thailand. CANCER INCIDENCE AND MORTALITY IN CHIANG MAI 2011. Published by the Academic Publishing Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Wiangnon S, Jetsrisuparb A, Komvilaisak P, Suwanrungruang K. Childhood cancer incidence and survival 1985- 2009, Khon Kaen, Thailand. Asian Pac J Cancer Prev. 2014; 15: 7989-93.
Gatta G, Botta L, Rossi S, Aareleid T, Bielska-Lasota M, Clavel J, et al. Childhood cancer survival in Europe 1999–2007: results of EUROCARE-5—a population- based study. Avaliable from: ttp://www.eurocare.it/LinkClick.aspx?fileticket=hcgmq6vAq6Y%3D&tabid=61.
Seksarn P. Outcome of childhood leukemia, ThaiPOG study. Proceedings of the 5th St. Jude-VIVA forum in pediatric oncology; 2011 March 21; Shangri-La Hotel, Singapore; 2011.
Wiangnon S, Veerakul G, Nuchprayoon I, Seksarn P, Hongeng S, Krutvecho T, et al. Childhood cancer incidence and survival 2003-5, Thailand: study from the Thai Pediatric Oncology Group. Asian Pac J Cancer Prev. 2011; 12:2215-20.
Ghimire KB, Shah BK. Survival in Adult Acute Lymphoblastic Leukemia Survival by Age, Gender and Ethnicity. Blood 2013; 122:1696.
Gökbuget N and Hoelzer D. Treatment of adult acute lymphoblastic leukemia. Semin Hematol. 2009; 46:64-75.
Kozlowski P, Åström M, Ahlberg L, Bernell P, Hulegårdh E, Hägglund H, et al. High relapse rate of T cell acute lymphoblastic leukemia in adults treated with Hyper-CVAD chemotherapy in Sweden. Eur J Haematol. 2014; 92:377-81.
Pui CH, Campana D, Pei D. Treatment of Children Acute Lymphoblastic Leukemia Without rophylactic Cranial Irradiation. N Engl J Med. 2009; 360: 2730–2741.
Conter V, Schrappe M, Aricó M, Reiter A, Rizzari C, Dördelmann M, et al. Role of cranial radiotherapy for childhood T-cell acute lymphoblastic leukemia with high WBC count and good response to prednisone. Associazione Italiana Ematologia Oncologia Pediatrica and the Berlin-Frankfurt-Münster groups. J Clin Oncol. 1997; 15:2786-91.
PDQ Adult Treatment Editorial Board. Adult Acute Lymphoblastic Leukemia Treatment (PDQ®): Health Professional Version [Online]. [cited 2018 March 30], Available from: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032602/
American Cancer Society. Acute Lymphocytic Leukemia (ALL) in Adults [Online]. [cited 2018 March 30]. Available from: https://www.cancer.org/cancer/acute-lymphocyticleukemia.html.
Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E, et al. Cancer statistics, 2004. CA Cancer J Clin. 2004; 54:8–29.
Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006; 56:106–130.
Fullmer A, O’Brien S, Kantarjian H, Jabbour E. Novel Therapies for Relapsed Acute Lymphoblastic Leukemia. Curr Hematol Malig Rep. 2009; 4: 148–156.
Joyce M, Pollock BH, Devidas M, Buchanan G, Camitta B. Chemotherapy for Initial Induction Failures in Children Acute Lymphoblastic Leukemia: a Children’s Oncology Group Study (POG 8764). J Pediatr Hematol Oncol. 2013; 35:32–35.
Lee JW, Cho B. Prognostic factors and treatment of children acute lymphoblastic leukemia. Korean J Pediatr. 2017; 60:129–137.
Terwilliger T, Abdul-Hay M. Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood Cancer J. 2017; 7:e577.
Schrappe M, Reiter A, Ludwig WD, Harbott J, Zimmermann M, Hiddemann W, et al. Improved outcome in children acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: results of trial ALL-BFM 90. German-Austrian-Swiss ALL-BFM Study Group. Blood. 2000; 95: 3310-3322.
Silverman LB, Gelber RD, Dalton VK, Asselin BL, Barr RD, Clavell LA, et al. Improved outcome for children with acute lymphoblastic leukemia: results of Dana-Farber Consortium Protocol 91-01. Blood. 2001; 97: 1211-1218.
Pui CH, Evans WE. Treatment of acute lymphoblastic leukemia. N Engl J Med. 2006; 354:166–178.
Stock W, La M, Sanford B, Bloomfield CD, Vardiman JW, Gaynon P, et al. What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children’s Cancer Group and Cancer and Leukemia Group B studies. Blood. 2008; 112: 1646–1654.
Hoelzer D, Thiel E, Loffler H, Büchner T, Ganser A, Heil G, et al. Prognostic factors in a multicenter study for treatment of acute lymphblastic leukemia in adults. Blood. 1988; 71:123-131.
Goldstone AH, Richards SM, Lazarus HM, Tallman MS, Buck G, Fielding AK, et al. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood journal. 2008; 111:1827-1833.
Pulte D, Redaniel MT, Jansen L, Brenner H, Jeffreys M. Recent trends in survival of adult patients with acute leukemia: overall improvements, but persistent and partly increasing disparity in survival of patients from minority groups. Haematologica. 2013; 98: 222–229.
Oriol A, Vives S, Hernández-Rivas JM, Tormo M, Heras I, Rivas C, et al. Outcome after relapse of acute lymphoblastic leukemia in adult patients included in four consecutive risk-adapted trials by the PETHEMA Study Group. Haematologica. 2010; 95: 589–596.
Locatelli F, Schrappe M, Bernardo ME, Rutella S. How I treat relapsed children acute lymphoblastic leukemia. Blood journal. 2012; 120: 2807-2816.
Cancela CS, Murao M, Viana MB, de Oliveira BM. Incidence and risk factors for central nervous system relapse in children and adolescents with acute lymphoblastic leukemia.Rev Bras Hematol Hemoter. 2012; 34: 436–441.
Thai Pediatric Oncology Group. Practical guidelines: Leukemia in children. Bangkok, National Health Security Office (NHSO). [Online]. 2006 [cited 2018 Mar 30], Available from: https://www.nhso.go.th/frontend/page-forhospital_cpg.aspx
Conter V, Schrappe M, Aricó M, Reiter A, Rizzari C, Dördelmann M, et al. Role of cranial radiotherapy for children T-cell acute lymphoblastic leukemia with high WBC count and good response to prednisone. Associazione Italiana Ematologia Oncologia Childrena and the Berlin-Frankfurt-Münster groups. J Clin Oncol. 1997; 15:2786-91.
Hata M, Ogino I, Aida N, Saito K, Omura M, Kigasawa H, et al. Prophylactic cranial irradiation of acute lymphoblastic leukemia in children: outcomes of late effects on pituitary function and growth in long-term survivors. Int J Cancer. 2001; 96 Suppl: 117-124.
Giordano FA, Welzel G, Abo-Madyan Y, Wenz F. Potential toxicities of prophylactic cranial irradiation. Transl Lung Cancer Res. 2012; 1: 254–262.
Meshref MM, Elshazly N, Nasr M, Abdelhai R. Effect of prophylactic cranial irradiation dose on CNS relapse, late cognitive decline and learning disabilities in children treated for acute lymphoblastic leukemia. J Clin Oncol. 2006 24:18_suppl, 9032-9032.
Waber DP, Turek J, Catania L, Stevenson K, Robaey P, Romero I, et al. Neuropsychological outcomes from a randomized trial of triple intrathecal chemotherapy compared with 18 Gy cranial radiation as NS treatment in acute lymphoblastic leukemia: findings from Dana-Farber Cancer Institute ALL Consortium Protocol 95-01. J Clin Oncol. 2007; 25:4914-21.
Chemaitilly W, Li Z, Huang S, Ness KK, Clark KL, Green DM, et al. Anterior hypopituitarism in adult survivors of children cancers treated with cranial radiotherapy: a report from the St Jude Lifetime Cohort study. J Clin Oncol. 2015; 33: 492-500.
Löning L, Zimmermann M, Reiter A, Kaatsch P, Henze G, Riehm H, et al. Secondary neoplasms subsequent to Berlin-Frankfurt-Münster therapy of acute lymphoblastic leukemia in children: significantly lower risk without cranial radiotherapy. Blood. 2000; 95:2770-5.
Pui CH, Cheng C, Leung W, Rai SN, Rivera GK, Sandlund JT, et al. Extended follow-up of long-term survivors of children acute lymphoblastic leukemia. N Engl J Med. 2003; 349:640-649.
Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25676887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015; 385:977-1010.
Hunger SP, Lu X, Devidas M, Camitta BM, Gaynon PS, Winick NJ, et al. Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the children’s oncology group. J Clin Oncol. 2012; 30: 1663-9.
Seksarn P, Wiangnon S , Veerakul G, Chotsampancharoen T, Kanjanapongkul S, Chainansamit S. Outcome of Children Acute Lymphoblastic Leukemia Treated Using the Thai National Protocols. Asian Pac J Cancer Prev. 2015:16, 4609-4614.
Hallböök H, Gustafsson G, Smedmyr B, Söderhäll S, Heyman M; Swedish Adult Acute Lymphocytic Leukemia Group. Treatment outcome in young adults and children >10 years of age with acute lymphoblastic leukemia in Sweden: a comparison between a pediatric protocol and an adult protocol. cancer. 2006; 107:1551-61.
Jaime-Pérez JC, Jiménez-Castillo RA, Herrera-Garza JL, Gutiérrez-Aguirre H, Marfil-Rivera LJ, Gómez-Almaguer D. Survival Rates of Adults with Acute Lymphoblastic Leukemia in a Low-Income Population: A Decade of Experience at a Single Institution in Mexico. Clin Lymphoma Myeloma Leuk. 2017; 17:60-68.
Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of medicine, Chiang Mai University, Chiang Mai, Thailand. CANCER INCIDENCE AND MORTALITY IN CHIANG MAI 2011. Published by the Academic Publishing Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Wiangnon S, Jetsrisuparb A, Komvilaisak P, Suwanrungruang K. Childhood cancer incidence and survival 1985- 2009, Khon Kaen, Thailand. Asian Pac J Cancer Prev. 2014; 15: 7989-93.
Gatta G, Botta L, Rossi S, Aareleid T, Bielska-Lasota M, Clavel J, et al. Childhood cancer survival in Europe 1999–2007: results of EUROCARE-5—a population- based study. Avaliable from: ttp://www.eurocare.it/LinkClick.aspx?fileticket=hcgmq6vAq6Y%3D&tabid=61.
Seksarn P. Outcome of childhood leukemia, ThaiPOG study. Proceedings of the 5th St. Jude-VIVA forum in pediatric oncology; 2011 March 21; Shangri-La Hotel, Singapore; 2011.
Wiangnon S, Veerakul G, Nuchprayoon I, Seksarn P, Hongeng S, Krutvecho T, et al. Childhood cancer incidence and survival 2003-5, Thailand: study from the Thai Pediatric Oncology Group. Asian Pac J Cancer Prev. 2011; 12:2215-20.
Ghimire KB, Shah BK. Survival in Adult Acute Lymphoblastic Leukemia Survival by Age, Gender and Ethnicity. Blood 2013; 122:1696.
Gökbuget N and Hoelzer D. Treatment of adult acute lymphoblastic leukemia. Semin Hematol. 2009; 46:64-75.
Kozlowski P, Åström M, Ahlberg L, Bernell P, Hulegårdh E, Hägglund H, et al. High relapse rate of T cell acute lymphoblastic leukemia in adults treated with Hyper-CVAD chemotherapy in Sweden. Eur J Haematol. 2014; 92:377-81.
Pui CH, Campana D, Pei D. Treatment of Children Acute Lymphoblastic Leukemia Without rophylactic Cranial Irradiation. N Engl J Med. 2009; 360: 2730–2741.
Conter V, Schrappe M, Aricó M, Reiter A, Rizzari C, Dördelmann M, et al. Role of cranial radiotherapy for childhood T-cell acute lymphoblastic leukemia with high WBC count and good response to prednisone. Associazione Italiana Ematologia Oncologia Pediatrica and the Berlin-Frankfurt-Münster groups. J Clin Oncol. 1997; 15:2786-91.
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2019-06-27
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Bunyatisai W, Jia-Mahasap B, Chitapanarux I. Treatment Outcomes of Acute Lymphoblastic Leukemia in both children and adults using the Thai Pediatric Oncology Group-based protocol at Chiang Mai University hospital. J Thai Assn of Radiat Oncol [Internet]. 2019 Jun. 27 [cited 2024 Jul. 3];25(1):12-28. Available from: https://he01.tci-thaijo.org/index.php/jtaro/article/view/203011
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