title: Cure rates of childhood acute lymphoblastic leukemia in Lithuania and the benefit of joining international treatment protocol.
abstract: BACKGROUND
  Childhood acute lymphoblastic leukemia (ALL) represents the largest group of pediatric malignancies with long-term survival rates of more than 80% achieved in developed countries. Epidemiological data and survival rates of childhood ALL in Lithuania were lacking. Therefore, the aim of this study was to analyze the population-based long-term treatment results of childhood ALL in Lithuania during 1992-2012.
  
  
  METHODS
  Data of all 459 children with T-lineage and B-cell precursor ALL treated in Lithuania from 1992 to 2012 were collected and analyzed. Results were compared among four time-periods: 1992-1996 (N=132), 1997-2002 (N=136), 2003-2008 (N=109) and 2009-2012 (N=82).
  
  
  RESULTS
  The incidence of childhood ALL in Lithuania was 3.2-3.6 cases per 100000 children per year during the study period. Five-year probability of event-free survival increased from 50%± 4% in 1992-1996 to 71%± 4% in 2003-2008 (P<0.001). Five-year cumulative incidence of relapses reduced from 27%± 4.5% in 1992-1996 to 14%± 3.6% in 2003-2008 (P=0.042). After introduction of high-dose methotrexate of 5 g/m(2), cumulative incidence of CNS-involving relapses reduced from 17%± 3.9% in 1992-1996 to 1%± 1.0% in 2003-2008 (P<0.001). Trend for further improvement in survival was seen in 2009-2012 when Lithuania joined international the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL-2008 treatment protocol.
  
  
  CONCLUSIONS
  Cure rates of childhood ALL in Lithuania are improving steadily and are now approaching those reported by the largest international study groups. The reasons for such a positive effect are both better financial support for treatment of children with cancer in Lithuania and international collaboration with joining international treatment protocol for childhood ALL.
authors: Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Clinic for Paediatric and Adolescent Medicine, Juliane Marie Centre, University Hospital Rigshospitalet, Copenhagen, Denmark. Electronic address: goda.vaitkeviciene@vuvl.lt.
authors: Goda
authors: G
authors: Vaitkevičienė
authors: Laboratory Diagnostics Centre, Vilnius University Hospital Santariškių Clinics, Vilnius, Lithuania; Physiology, Biochemistry, and Laboratory Medicine Department, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
authors: Rėda
authors: R
authors: Matuzevičienė
authors: Hematology, Oncology, and Transfusion Medicine Center, Vilnius University Hospital Santariškių Clinics, Vilnius, Lithuania.
authors: Mindaugas
authors: M
authors: Stoškus
authors: Hematology, Oncology, and Transfusion Medicine Center, Vilnius University Hospital Santariškių Clinics, Vilnius, Lithuania.
authors: Tadas
authors: T
authors: Žvirblis
authors: Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
authors: Lina
authors: L
authors: Ragelienė
authors: Clinic for Paediatric and Adolescent Medicine, Juliane Marie Centre, University Hospital Rigshospitalet, Copenhagen, Denmark; Institute of Gynaecology, Obstetrics and Paediatrics, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Kjeld
authors: K
authors: Schmiegelow
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008097:Lithuania; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D008727:Methotrexate
keywords: Acute lymphoblastic leukemia; Children; Cumulative incidence of relapses; Event-free survival; International collaboration