title: The inferior prognosis of adolescents with acute lymphoblastic leukaemia (ALL) is caused by a higher rate of treatment-related mortality and not an increased relapse rate--a population-based analysis of 25 years of the Austrian ALL-BFM (Berlin-Frankfurt-Münster) Study Group.
abstract: Adolescents aged 15-18 years with acute lymphoblastic leukaemia (ALL) have been historically reported to have a poorer prognosis than younger children. We retrospectively analysed the characteristics and outcome of 67 adolescents included in a population-based series of 1125 non-infant cases that were enrolled into four Austrian ALL-BFM (Berlin-Frankfurt-Münster) multicentre trials at paediatric institutions within a 25-year period. Five-year event-free survival (EFS) and overall survival (OS) were 66 ± 6% and 76 ± 5% respectively, and thus lower than in younger children (83 ± 1%, 91 ± 1%; P < 0·001). This was not due to an increased cumulative incidence of relapse (CIR) (5-year CIR: 19 ± 5% vs. 13 ± 1%; P = 0·284), but due to an increased incidence of treatment-related death [5-year cumulative incidence of death (CID): 15 ± 4% vs. 3 ± 0%; P < 0·001] as a first event. Furthermore, while 44/67 (66%) non-high-risk adolescents had favourable 5-year EFS and OS rates (76 ± 7%, 89 ± 5%), 18/67 (27%) high-risk adolescents had an inferior outcome (5-year EFS: 56 ± 12%, OS 61 ± 11%, P < 0·05). Among the latter patients the CID was significantly higher than in younger high-risk children (22 ± 10% vs. 6 ± 2%; P = 0·020). Given that adolescent age is an independent risk factor for death as a first event, this specific age group may need particular vigilance when receiving intense BFM-type chemotherapy, as relapse-free survival is similar to younger children.
authors.affiliation: Paediatric Haematology and Oncology, St Anna Children's Hospital, Department of Paediatrics, Medical University of Vienna, Vienna, Austria.
authors.forename: Herbert
authors.initials: H
authors.lastname: Pichler
authors.forename: Bettina
authors.initials: B
authors.lastname: Reismüller
authors.forename: Manuel
authors.initials: M
authors.lastname: Steiner
authors.forename: Michael N
authors.initials: MN
authors.lastname: Dworzak
authors.forename: Ulrike
authors.initials: U
authors.lastname: Pötschger
authors.forename: Christian
authors.initials: C
authors.lastname: Urban
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meister
authors.forename: Klaus
authors.initials: K
authors.lastname: Schmitt
authors.forename: Renate
authors.initials: R
authors.lastname: Panzer-Grümayer
authors.forename: Oskar A
authors.initials: OA
authors.lastname: Haas
authors.forename: Andishe
authors.initials: A
authors.lastname: Attarbaschi
authors.forename: Georg
authors.initials: G
authors.lastname: Mann
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001317:Austria / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome