title: Risk group assignment differs for children and adults 1-45 yr with acute lymphoblastic leukemia treated by the NOPHO ALL-2008 protocol.
abstract: BACKGROUND
  The prognosis of acute lymphoblastic leukemia is poorer in adults than in children. Studies have indicated that young adults benefit from pediatric treatment, although no upper age limit has been defined.
  
  
  METHODS
  We analyzed 749 patients aged 1-45 yr treated by the NOPHO ALL-2008 protocol. Minimal residual disease (MRD) on days 29 and 79, immunophenotype, white blood cell count (WBC), and cytogenetics were used to stratify patients to standard-, intermediate-, or high-risk treatment with or without hematopoietic stem cell transplantation.
  
  
  RESULTS
  Adults aged 18-45 had significantly lower WBCs at diagnosis compared with children aged 1-9 and 10-17 yr, but significantly more adults were stratified to high-risk chemotherapy (8%, 14%, 17%; P < 0.0001) or high-risk chemotherapy with transplantation (4%, 13%, 19%; P < 0.0001). This age-dependent skewing of risk grouping reflected more T-ALL (11%, 27%, 33%, P < 0.0001), poorer MRD response day 29 (MRD < 0.1%: 75%, 61%, 52%; P < 0.0001), and more MLL gene rearrangements (3%, 3%, 10%; P = 0.005) in older patients.
  
  
  CONCLUSIONS
  Even if identical diagnostics, treatment, and risk stratification are implemented, more adults will be stratified to high-risk therapy, which should be considered when comparing pediatric and adult outcomes.
authors: Department of Hematology, Herlev University Hospital, University of Copenhagen, Herlev, Denmark.
authors: Nina
authors: N
authors: Toft
authors: Henrik
authors: H
authors: Birgens
authors: Jonas
authors: J
authors: Abrahamsson
authors: Per
authors: P
authors: Bernell
authors: Laimonas
authors: L
authors: Griškevičius
authors: Helene
authors: H
authors: Hallböök
authors: Mats
authors: M
authors: Heyman
authors: Mette Skov
authors: MS
authors: Holm
authors: Erik
authors: E
authors: Hulegårdh
authors: Tobias Wirenfeldt
authors: TW
authors: Klausen
authors: Hanne V
authors: HV
authors: Marquart
authors: Olafur Gísli
authors: OG
authors: Jónsson
authors: Ove Juul
authors: OJ
authors: Nielsen
authors: Petter
authors: P
authors: Quist-Paulsen
authors: Mervi
authors: M
authors: Taskinen
authors: Goda
authors: G
authors: Vaitkeviciene
authors: Kim
authors: K
authors: Vettenranta
authors: Ann
authors: A
authors: Åsberg
authors: Kjeld
authors: K
authors: Schmiegelow
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D020732:Cytogenetic Analysis; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D060828:Induction Chemotherapy; D007223:Infant; D008297:Male; D055118:Medication Adherence; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D011241:Prednisone / Q000008:administration & dosage; D012042:Registries; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D011241:Prednisone; D008727:Methotrexate