title: Long-term results of Taiwan Pediatric Oncology Group studies 1997 and 2002 for childhood acute lymphoblastic leukemia.
abstract: The long-term outcome of 1390 children with acute lymphoblastic leukemia (ALL), treated in two successive clinical trials (Taiwan Pediatric Oncology Group (TPOG)-ALL-97 and TPOG-ALL-2002) between 1997 and 2007, is reported. The event-free survival improved significantly (P=0.0004) over this period, 69.3+/-1.9% in 1997-2001 to 77.4+/-1.7% in 2002-2007. A randomized trial in TPOG-97 testing L-asparaginase versus epidoxorubicin in combination with vincristine and prednisolone for remission induction in standard-risk (SR; low-risk) patients yielded similar outcomes. Another randomized trial, in TPOG-2002, showed that for SR patients, two reinduction courses did not improve long-term outcome over one course. Decreasing use of prophylactic cranial irradiation in the period 1997-2008 was not associated with increased rates of CNS relapse, prompting complete omission of prophylactic cranial irradiation from TPOG protocols, beginning in 2009. Decreased use of etoposide and cranial irradiation likely contributed to the low incidence of second cancers. High-risk B-lineage ALL, T-cell, CD10 negativity, t(9;22), infant, and higher leukocyte count were consistently adverse factors, whereas hyperdiploidy >50 was a consistently favorable factor. Higher leukocyte count and t(9;22) retained prognostic significance in both TPOG-97 and TPOG-2002 by multivariate analysis. Although long-term outcome in TPOG clinical trials is comparable with results being reported worldwide, the persistent strength of certain prognostic variables and the lower frequencies of favorable outcome predictors, such as ETV6-RUNX1 and hyperdiploidy >50, in Taiwanese children warrant renewed effort to cure a higher proportion of patients while preserving their quality of life.
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
authors.forename: D-C
authors.initials: DC
authors.lastname: Liang
authors.forename: C-P
authors.initials: CP
authors.lastname: Yang
authors.forename: D-T
authors.initials: DT
authors.lastname: Lin
authors.forename: I-J
authors.initials: IJ
authors.lastname: Hung
authors.forename: K-H
authors.initials: KH
authors.lastname: Lin
authors.forename: J-S
authors.initials: JS
authors.lastname: Chen
authors.forename: C-C
authors.initials: CC
authors.lastname: Hsiao
authors.forename: T-T
authors.initials: TT
authors.lastname: Chang
authors.forename: C-T
authors.initials: CT
authors.lastname: Peng
authors.forename: M-T
authors.initials: MT
authors.lastname: Lin
authors.forename: T-K
authors.initials: TK
authors.lastname: Chang
authors.forename: T-H
authors.initials: TH
authors.lastname: Jaing
authors.forename: H-C
authors.initials: HC
authors.lastname: Liu
authors.forename: L-Y
authors.initials: LY
authors.lastname: Wang
authors.forename: T-C
authors.initials: TC
authors.lastname: Yeh
authors.forename: S-T
authors.initials: ST
authors.lastname: Jou
authors.forename: M-Y
authors.initials: MY
authors.lastname: Lu
authors.forename: C-N
authors.initials: CN
authors.lastname: Cheng
authors.forename: J-M
authors.initials: JM
authors.lastname: Sheen
authors.forename: S-S
authors.initials: SS
authors.lastname: Chiou
authors.forename: K-H
authors.initials: KH
authors.lastname: Wu
authors.forename: G-Y
authors.initials: GY
authors.lastname: Hung
authors.forename: R-L
authors.initials: RL
authors.lastname: Chen
authors.forename: S-H
authors.initials: SH
authors.lastname: Chen
authors.forename: S-N
authors.initials: SN
authors.lastname: Cheng
authors.forename: Y-H
authors.initials: YH
authors.lastname: Chang
authors.forename: B-W
authors.initials: BW
authors.lastname: Chen
authors.forename: W-L
authors.initials: WL
authors.lastname: Ho
authors.forename: J-L
authors.initials: JL
authors.lastname: Wang
authors.forename: S-T
authors.initials: ST
authors.lastname: Lin
authors.forename: Y-L
authors.initials: YL
authors.lastname: Hsieh
authors.forename: S-C
authors.initials: SC
authors.lastname: Wang
authors.forename: H-H
authors.initials: HH
authors.lastname: Chang
authors.forename: Y-L
authors.initials: YL
authors.lastname: Yang
authors.forename: F-L
authors.initials: FL
authors.lastname: Huang
authors.forename: C-Y
authors.initials: CY
authors.lastname: Chang
authors.forename: W-H
authors.initials: WH
authors.lastname: Chang
authors.forename: K-S
authors.initials: KS
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002869:Chromosome Aberrations; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016130:Immunophenotyping; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D018365:Neoplasm, Residual; D016609:Neoplasms, Second Primary / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome