Outcomes Of Teenagers and Young Adults On The UKALL 2003 Paediatric Trial For Children and Young People With Acute Lymphoblastic Leukaemia

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 57-57 ◽  
Author(s):  
Clare Rowntree ◽  
Rachael E Hough ◽  
Rachel Wade ◽  
Nicholas Goulden ◽  
Chris Mitchell ◽  
...  
Keyword(s):  
Young Adults ◽  
High Risk ◽  
Young People ◽  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Low Risk ◽  
Age Group ◽  
Children And Young People ◽  
Teenagers And Young Adults ◽  
Risk Patients

Abstract Background Outcomes for adults with acute lymphoblastic leukaemia (ALL) have traditionally been inferior to outcomes for children, with differences in survival being noted from adolescence onwards. The reasons for the declining cure rates with increasing age are likely to be multi factorial but the choice of treatment protocol has been shown to play an important role in outcomes for teenagers and young adults (TYAs) with ALL. Over the past decade there has been increasing evidence of better outcomes for TYAs treated on paediatric regimens compared to adult regimens. Historically, 15-17 year olds treated on the adult UKALL XII trial had about 15% lower 5-year probability of both overall survival (OS) and event-free survival (EFS) compared to those treated on the corresponding paediatric ALL 97/99 trial during the same period, with the EFS difference not accounted for by age, gender, WBC or Ph status. (Ramanujachar et al. Pediatr Blood Cancer. 2007 Mar;48(3):254-61). UKALL 2003 was a randomised controlled trial investigating treatment modification according to Minimal Residual Disease (MRD) status at the end of induction and week 11, in consecutively diagnosed children and young people with Philadelphia negative ALL recruited from the UK and Republic of Ireland between October 2003 and June 2011. The trial was initially open to children up to the age of 18 years but the upper age limit was increased to 20th birthday in 2006 and 25th birthday in 2007. Here we report the outcomes for the 16 – 24 year old teenage and young adult (TYA) patients recruited to the trial from 2003-2011. Results A total of 229 out of 3126 patients entered were aged 16-24 years (7.3%), although only 56 patients were over 20 years of age at diagnosis. With follow up to October 2012, the 5-year EFS for the 16-24 year old cohort was 72% (95% CI: 66-79%) compared to an EFS for 1-10 year olds and 10-15 year olds of 90% (88-91%) and 84% (80-87%) respectively, p(trend)<0.0001. At the last analysis, 37 TYA patients had relapsed with a 5-year cumulative risk of relapse of 21% (14-27%), compared to 11% (8-14%) for the 10-15 year olds and 7% (6-9%) for the 1-10 year olds, p(trend)<0.0001. Within UKALL 2003 there was no significant increase in reported toxicities in the 16-24 year age group compared to the 10-15 year age group. The induction death rate was 2.2% for 16-24 year olds, 2.1% for 10-15 year olds and 1.2% for under 10 year olds. 53% of TYA patients had one or more serious adverse event (SAE) reported compared to 56% for 10-15 year olds and 31% for under 10 years. The SAEs reported were primarily infections and expected toxicities related to steroids, pegylated asparaginase and methotrexate. There was a trend (p=0.05) towards an increase in deaths in remission in the TYA age group at 6.1% compared to 3.1% in the 10-15 year olds. Outcomes in TYAs were analysed by MRD status as previously described (Vora et al. Lancet Oncol. 2013 Mar;14(3):199-209). There was an increase in the proportion of TYA patients with persistent MRD positivity compared to the younger patient groups; 49% were MRD high risk, 24% were MRD low risk and 27% MRD indeterminate compared to 32%, 36% and 32% respectively for patients under 16 years, p<0.0001. MRD was highly predictive of outcome in the TYA age group, as in the trial overall. Five-year EFS for those aged 16-24 was 64% (95% CI: 54-74%) for MRD high risk patients, 71% (58-84%) for MRD indeterminate and 93% (86-100%) for MRD low risk; MRD high risk vs low risk, p=0.0003. The TYA EFS compares favourably with the 10-15 year old cohort with EFS of 74% (68-81%), 83% (77-88%) and 95% (91-99%) respectively. Conclusion This large randomised study provides evidence that TYAs with ALL can be treated on a national paediatric trial with toxicities similar to those seen in younger teenagers. Outcomes are significantly improved using this approach in TYAs compared to the historical, transplant focused adult ALL regimens. MRD based risk stratification in this age group remains a valid approach with low risk patients having an unprecedented 93% EFS at 5 years. Further intensification of therapy for MRD high risk patients, possibly including transplantation may be required for the MRD high risk TYA patients and this question is being examined in the next national trial, UKALL 2011. Disclosures: No relevant conflicts of interest to declare.

Cancers in children, teenagers, and young adults

2020 ◽  
pp. 3-7
Author(s):  
Tom Boterberg ◽  
Karin Dieckmann ◽  
Mark Gaze
Keyword(s):  
Young Adults ◽  
Young People ◽  
Children And Young People ◽  
Teenagers And Young Adults ◽  
Total Cancer ◽  
The Common ◽  
Environmental Causes ◽  
Cure Rates ◽  
Cancer In Children

Chapter 1 introduces the topic of cancer in children, teenagers, and young adults. Cancer in children and young people is rare: less than 1% of total cancer incidence. There is a wide variety of tumour types, and these are often different from the common adult cancers. Leukaemia, brain tumours, and malignancies of embryonal origin are most common in younger children. Genetic predisposition is important. Environmental causes are less common than in adults. Treatments have improved significantly and, currently, about three out of four children and young people are cured of their cancer. Multimodality protocols including chemotherapy, surgery, and, more frequently now, biological treatment, in addition to selective use of more sophisticated radiotherapy techniques, is the norm. Increasing personalization of treatment based on risk stratification has allowed for improved cure rates with a reduction in treatment-related morbidity.

Barriers To Clinical Trial Enrolment For Teenagers and Young Adults With Acute Lymphoblastic Leukaemia: The Impact of Age Eligibility Criteria

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1401-1401
Author(s):  
Lorna Anne Fern ◽  
Clare Rowntree ◽  
Rachael E Hough ◽  
Ajay J Vora ◽  
Adele Fielding ◽  
...  
Keyword(s):  
Young Adults ◽  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Eligibility Criteria ◽  
Incidence Data ◽  
Paediatric Trial ◽  
Time Period ◽  
Teenagers And Young Adults ◽  
The Uk ◽  
The Impact

Abstract Background Overall survival (OS) for teenagers and young adults (TYA) aged 15-24 years (yrs) with acute lymphoblastic leukaemia (ALL) is inferior to OS for children. In the UK, five-year OS for children up to 14 years with ALL is 89%, falling to 69% for 15-19 yr olds and 52% for 20-24 yr olds (O'Hara et al, National Cancer Intelligence Network, 2013). Both disease biology and choice of protocol are likely to be important in explaining these differences. However, lower rates of inclusion into clinical trials with increasing age may also be a significant factor. In the UK 3 national paediatric and adult ALL trials were open to recruitment between 1997-2006 (table 1). In 2006 the upper age eligibility criteria for UKALL2003 was increased from 18 to 24 yrs and the lower age limit of UKALL XII was correspondingly increased to reflect emerging evidence that TYA have improved outcomes when treated on paediatric protocols. Aims 1. To examine trial accrual rates (AR) by age over a ten year period (1997-2006) to three UK national ALL trials. 2. To determine the influence of amending the age eligibility criteria for UKALL2003 on TYA accrual Methods ALL incidence figures for patients aged 1-39 yrs during the study period of 1997-2006 were obtained from a national cancer registry. Incidence data was classified according to the morphology-based coding specifically for TYA (Birch et al, BJC, 2002). Accrual rates (AR) were expressed as the ratio of patients entered onto trials during the same time period compared to incidence cases. Descriptive statistics were applied for an observational dataset where sample size or incidence cases cannot be controlled (Fern et al. BJC, 2008). We obtained a further incidence data set for cases diagnosed in 2007 and 2008 to examine the impact of age eligibility amendments in 2006 and 2008 to UKALL2003. Results ALL was diagnosed in 4,579 patients aged 1-39 yrs between 1997-2006, 2,767 were under 10 yrs. The figure shows the proportion of newly diagnosed ALL patients entering trials 1997-2006. Red arrows show age eligibility criteria of the trials. 65% of all patients were enrolled onto one of the 3 trials. AR were highest for under 10's (71.5%), declining to 55.2% for 15-16 yr olds, 43.4% for 17-18 yr olds and 40% for those aged 21-24 yrs. The amendments to age inclusion criteria for UKALL2003 and UKALL XII improved AR for 17-18 yr olds to a level equivalent to AR for 15-16 yr olds. AR for 19-20 yr olds also improved to 62.5%. However, recruitment of 21-24 year olds did not change. During 1997-2006 three quarters of 17-18 yr olds recruited to trials were enrolled onto UKALLXII. After protocol amendments, three quarters of 17-18 yrs were recruited to the paediatric trial. Conclusions We have shown a decline in trial accrual with increasing age for teenagers and young adults with ALL despite the availability of national trials spanning the age range being available during the time period studied. Due to close cooperation between adult and paediatric trial management groups, major changes were made to age eligibility criteria for both paediatric and adult trials, following increasing evidence that TYA have better outcomes when treated on paediatric protocols. We have shown an increased accrual of older teenagers to ALL trials in the UK following these changes. No improvements were observed for 21-24 year olds. However, this age group were only eligible for UKALL 2003 during the last year of our analysis. This approach to trial eligibility design may serve as a model for future trials, both in ALL and other cancers. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Cerebral Venous Thrombosis As a Complication of Treatment for Acute Lymphoblastic Leukaemia in Children and Young Adults

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 585-585
Author(s):  
Kathryn M Musgrave ◽  
Frederik W van Delft ◽  
Rachel M Clack ◽  
Elizabeth A Chalmers ◽  
Ajay J. Vora ◽  
...  
Keyword(s):  
Young Adults ◽  
Risk Factor ◽  
High Risk ◽  
Acute Lymphoblastic Leukaemia ◽  
Venous Thrombosis ◽  
Anticoagulant Therapy ◽  
Lymphoblastic Leukaemia ◽  
Cerebral Venous Thrombosis ◽  
Thrombotic Risk ◽  
Children And Young Adults

Abstract Cerebral venous thrombosis (CVT) is a significant complication of therapy in children and young adults with acute lymphoblastic leukaemia (ALL). Previous reports indicate a considerable risk of mortality and morbidity in relation to CVT. In addition, there is potential for suboptimal treatment of ALL due to avoidance of Asparaginase and the need for reversal of anticoagulant therapy for invasive procedures such as intrathecal chemotherapy. Anticoagulation may be complicated by haemorrhage. This retrospective study aimed to identify the clinical features, therapy and outcome of CVT occurring during treatment of ALL in individuals, aged 1 to 24 years, who participated in the Medical Research Council UK ALL 2003 (MRC UKALL 2003) randomised controlled trial. Cases of CVT were identified from adverse event reporting. All reports were screened for central nervous system thrombosis and grade 4 serious adverse events in the category of coagulation/thrombosis. Reporting centres were asked for additional clinical information. 3126 children and young adults were enrolled in the study between 2003 and 2011, with median age 5 years, including 1776 males (56.8%). The 3 initial treatment regimens: A, B and C: corresponded to standard-risk, intermediate-risk and high-risk, respectively. 55% were treated with regimen A, 32% regimen B and 13% regimen C. 48 individuals (1.5%) developed CVT and data were returned for 42. Median age was 10 (range: 1 to 18) years and 25 cases were male (59.5%). 71.4% of cases (30/42) occurred during induction therapy. 18 cases were in individuals treated with regimen A, 22 regimen B and 2 regimen C. Median time between the most recent Asparaginase dose and CVT was 12.5 days (range: 1-111 days). 29 cases (68.4%) had received 2 doses of Asparaginase prior to thrombosis, 5 cases >2 doses and 8 cases 1 dose. Presenting symptoms were: seizures, 22 cases (52.3%); neurological impairment, 20 (47.6%); headache, 19 (45.2%); reduced conscious level, 8 (19.0%); nausea/vomiting, 8 (19.0%). Identified thrombotic risk factors included: hospitalisation, 22 (52.3%); active infection, 5; recent immobility, 5; dehydration, 6; combined oral contraceptive pill, 2. None were obese, had a high white cell count at time of CVT diagnosis or a history of recent major surgery. 13 (31.0%) had >1 thrombotic risk factor and 16 (38.1%) had no additional clinical risk factor identified. 10 had a thrombophilia screen performed, one with a repeatedly low protein S level (male, 1 year of age). 7 cases (16.7%) had cerebral infarction on imaging and 11 (26.2%) were complicated by intracranial haemorrhage (ICH). 38 cases (90.5%) received anticoagulant therapy, 37 of which received low molecular weight heparin (LMWH) and one unfractionated heparin. One case had catheter-directed thrombolysis. 4 were not anticoagulated, 3 due to ICH. 2 received Antithrombin replacement therapy. Anticoagulation therapy was continued for a median of 3 months. 65.0% of cases due more Asparaginase were re-exposed (26/40), 19 of which received thromboprophylaxis during re-exposure. 2 remain on long-term therapeutic anticoagulation. In 23 cases (54.8%) CVT resulted in a delay or change to planned treatment. Neurological morbidity was reported in 4 cases (9.5%): seizure disorder, 2; hemiplegia, 1; residual hemiplegia and hemianopia with severe developmental delay, 1. 36 cases (85.7%) remain in first remission. Survival in those with CVT was 90.1%, comparable to actuarial 5-year survival of the entire cohort (91.5%). There were 4 deaths, three due to leukaemia (two in first relapse) and one due to pneumonia as a complication of stem cell transplant. There were no deaths due to CVT or bleeding on anticoagulant therapy. This study highlights the clinical features of CVT in children and young adults treated for ALL in the MRC UKALL 2003 trial, in particular the timing in relation to Asparaginase treatment, presenting features and neurological outcome. These data support LMWH as safe treatment for CVT in this clinical setting. We have demonstrated the tendency of clinicians to adjust treatment regimen and/or avoid further Asparaginase exposure in response to CVT. However, overall survival at 5 years did not differ for the cohort with CVT. Future studies should aim to further evaluate clinical predictors, alongside potential coagulation and genetic markers, in order to identify a high-risk group that may benefit from measures to reduce CVT during ALL therapy. Disclosures No relevant conflicts of interest to declare.

scholarly journals Major Deviations in the Delivery of Induction Chemotherapy Are Associated with an Increased Risk of Relapse in Acute Lymphoblastic Leukaemia: Results from UKALL2003

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2579-2579
Author(s):  
Rachael E Hough ◽  
Amy A Kirkwood ◽  
Sujith Samarasinghe ◽  
Clare J Rowntree ◽  
Nicholas John Goulden ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Young People ◽  
Acute Lymphoblastic Leukaemia ◽  
Induction Chemotherapy ◽  
Lymphoblastic Leukaemia ◽  
Children And Young People ◽  
Increased Risk ◽  
The Impact ◽  
Dose Reductions ◽  
Risk Of Relapse

Introduction As survival rates for acute lymphoblastic leukaemia (ALL) in children and young people improve, the need to understand and mitigate toxicity becomes increasingly important. The contribution of toxicity to mortality or significant morbidity is well described. However, the impact of dose reductions, drug omissions or delays in treatment which result from toxicity is poorly understood, other than the established association between effective count suppression during maintenance chemotherapy and a reduction in relapse rate. We report the significance of treatment delays and dose reductions in induction chemotherapy in the UKALL2003 trial. Methods UKALL2003 was a prospective multicenter phase 3 study recruiting patients aged 1-24 years with newly diagnosed Philadelphia chromosome negative ALL in the UK. Data regarding 4 different protocol deviations were prospectively collected at the end of each block of therapy; a) not given allocated regimen, b) <90% of one or more of the protocol drugs administered, c) change of Asparaginase product and d) delay of > 1 week in commencing the next treatment block. Univariable (UVA) and Multivariable (MVA) Cox regression was used to assess the association of each deviation with risk of relapse. To control for immortality bias, this was assessed at the end of each therapy block with only patients alive and relapse free at the end of the block included in the analysis. Patients with Down Syndrome were excluded from all analyses. Results Of 2991 patients without Down Syndrome completing induction chemotherapy, 9 patients did not receive the allocated regimen, 1558 patients received <90% of one or more drugs, 9 patients were switched to an alternative Asparaginase product and 72 had a greater than 1 week delay in commencing consolidation. On UVA, reduction of >90% of one or more drugs and delay of greater than 1 week was significantly associated with an increased risk of relapse with hazard ratios of 1.70 (95% CI 1.11 - 2.60, p=0.014) and 1.99 (95% CI 1.14 - 3.48, p=0.013) respectively. On MVA (complete cases, n=2464), including other factors of established prognostic significance, both deviations remained significantly associated with an increased risk of relapse (Table 1). The impact of a major deviation (defined here as dose reduction of >90% of one or more drugs or treatment delay of >1week) was seen in both the paediatric (<16 years) and older (16-24 years) groups with a slightly larger effect in the older group (HRs 1.73 and 2.40 respectively), though the interaction between age and deviation was not significant (p=0.49)( Figure 1). Patients with dose omissions >90% of one or more drugs in induction were also more likely to have major deviations in subsequent blocks of therapy (p<0.001) and remained at significantly higher risk of relapse when starting the maintenance phase of treatment (n=2343, HR: 1.81 (1.06 - 3.09, p = 0.03). Conclusion Major deviations in the delivery of induction chemotherapy on UKALL2003 were significantly associated with a greater risk of further deviations in subsequent blocks of therapy and a higher risk of relapse. Further improvement in efficacy of ALL therapy in children and young people will require a greater understanding of which toxicities lead to major deviations in therapy and strategies developed to mitigate these risks. Disclosures Rowntree: Novartis: Consultancy.

Predictive Role of Flow Cytometry in Assessing Very Early Treatment Response in Childhood ALL.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4266-4266
Author(s):  
J. Motwani ◽  
J. Jesson ◽  
E. Sturch ◽  
L. Eyre ◽  
P. Short ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Treatment Protocol ◽  
Early Response ◽  
Low Risk ◽  
Childhood All ◽  
Specificity And Sensitivity ◽  
Cure Rates ◽  
Risk Of Relapse

Abstract Acute lymphoblastic leukaemia is the most common childhood malignancy. In the modern treatment of acute leukaemia, advances in supportive care have allowed the intensification of therapy, and survival rates have risen accordingly. Cure rates in childhood acute lymphoblastic leukaemia (ALL) have increased from 10% to 80% over the last four decades. Currently clinical parameters such as white blood cell count and age at diagnosis are used for treatment stratification. This stratification aims to maximise the efficacy and minimize the toxicity of treatment, with the intensity of treatment being adjusted according to the risk of relapse. Unfortunately, the clinical and biologic parameters most commonly used for risk classification fail to identify all patients who relapse, with most patients who relapse falling into the ‘low risk’ group. In addition other patients who are actually at low risk of relapse may receive more intensive treatment than is necessary. Morphology is used to assess very early response at day 8/15, but lacks specificity and sensitivity. Many publications have reported marked variability in indivual reports of morphological blast %. Better techniques of assessing very early response are therefore needed. Detection of minimal residual disease (MRD) allows better estimation of the leukaemic burden and can help selection of appropriate therapeutic strategies. Flow cytometric (FC) detection of MRD is based on the identification of immunophenotypic combinations expressed on leukaemic cells but not on normal hematopoietic cells - leukaemia associated immunophenotypes (LAIPs). FC analysis is an attractive option as it is quick and more specific. We prospectively analysed bone marrow samples from 70 patients who presented with ALL to our unit between 1999–2003 and attained morphological remission. These patients were treated on a standard protocol. Multiparameter FC identification of LAIPs was performed at various time points, as dictated by the treatment protocol. We looked at the predictive value of FC at d8/15 on treatment, at different levels of MRD. Our results showed that amongst children with flow MRD< 0.01% (n=5) on day 8/15 of chemotherapy, there were no relapses. Perhaps this cohort of patients could receive less intensive chemotherapy to minimise long-term side effects. The second group was children with flow MRD between 0.01%– 1%(n=33). In this group we saw 14% relapses. The third group was children with flow MRD between 1–10% (n=20), in which we observed 25% relapses. The fourth group was children with flow MRD > 10%, (n=12). 40% of this group suffered relapses. It appears that as early as day 8/15 of treatment, we can identify patients who are at very high risk of relapse, and perhaps these children need intensification of chemotherapy early on or some other novel intervention eg stem cell transplantation. FC appears to offer the ability to identify very early in treatment those at high risk of relapse and those with a high chance of cure. Treatment may therefore be stratified according to these risks with the aim of improving cure rates. These results need to be confirmed in a larger cohort of patients but these preliminary results are very promising in the risk stratification of childhood ALL.

UKALL 2003, A Randomised Trial Investigating Treatment Reduction for Children and Young Adults with Minimal Residual Disease Defined Low Risk Acute Lymphoblastic Leukaemia

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 496-496 ◽  
Author(s):  
Ajay J. Vora ◽  
Chris Mitchell ◽  
Nicholas Goulden ◽  
Sue Richards
Keyword(s):  
Young Adults ◽  
High Risk ◽  
Residual Disease ◽  
Early Response ◽  
Low Risk ◽  
Number Of Patients ◽  
Risk Patients ◽  
Children And Young Adults ◽  
Grade 3 ◽  
Minimal Residual

Abstract Abstract 496 UKALL 2003 is an ongoing randomised controlled trial investigating treatment modification according to Minimal Residual Disease (MRD) status at the end of induction and week 11 in children and young adults (up to age 25 years) with ALL. Whilst the randomisation testing the benefit of intensification for an MRD defined high risk group remains open, a treatment reduction randomisation for MRD low risk patients closed in August 2009 after recruiting the target number of patients. Over 2600 patients have so far been enrolled into the trial and we have observed a significant improvement in 5 year event-free (EFS) compared with its predecessor, ALL 97/99, (EFS 87 vs 80%, p<0.0005), most probably related to use of dexamethasone and pegylated asparaginase in all patients. Here we report the results of the MRD low risk randomisation. Patients in the trial are initially stratified by NCI risk, blast karyotype, and morphological marrow response at day 8/15 of induction for allocation to one of 3 treatment regimens, escalating in intensity (A, B, C). NCI standard risk (SR) patients receive a 3 drug induction (Regimen A) whilst high risk (HR) patients receive 4 drugs including daunorubicin (Regimen B). Patients with a slow early response at day 8 (NCI HR) or day 15 (NCI SR) of induction and patients with poor risk cytogenetics are transferred to Regimen C. Patients without poor risk cytogenetics and who have a rapid early response are eligible for the MRD randomisations. MRD was measured using Real Time Quantitative PCR with a sensitivity of 10−4. Five hundred and twenty-one patients who were either MRD negative at day 29 of induction or positive < 10−4 at day 29 but negative by week 11 entered a randomisation comparing two courses of delayed intensification (standard arm, n = 261) with one (treatment reduction arm, n = 260). Of these patients, 342 (65%) were NCI SR and 179 (35%) NCI HR. With follow-up to October 2009 (median 2 years 9 months), there is no difference in 5 year EFS for patients in the standard (94%) or reduced treatment arms (96%). As shown in table 1, the number of patients with relapse is similar in both arms but there was a non-significant excess of deaths in remission, serious adverse events and grade 3/4 toxicity in recipients of 2 DIs. 7/10 relapses have involved the CNS. The 3 CR deaths in the 2 DI arm were due to gram negative sepsis (DI1), pulmonary haemorrhage (DI2) and RSV pneumonitis (Maintenance, Down). There have been no relapses or CR deaths among 23 MRD low risk patients in the 16 – 25 age group. Table 1 1DI 2DI Statistics for 2DI Obs/N Obs/N Odds ratio(95% CI) 2p Any event 6/260 7/261 1.19 (0.40–3.53) 0.76 Relapse 6/260 4/261 0.69 (0.20–2.38) 0.57 Remission death 0/260 3/261 7.40 (0.77–71.14) 0.08 Grade 3/4 toxicity 177 (68%) 191 (71%) 0.2 SAEs 64 (25%) 77 (29.5%) 0.2 This randomised study provides evidence that treatment can be reduced for around 40% of children and young adults who show rapid clearance of MRD by the end of induction. These patients have an excellent outcome with < 5% risk of relapse on a treatment protocol that does not include cranial radiotherapy or high dose methotrexate and gives minimal exposure to anthracyclines and alkylating agents. Future trials should test the feasibility of further reductions in treatment for this group of patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Outcome for children and young people with Early T-cell precursor acute lymphoblastic leukaemia treated on a contemporary protocol, UKALL 2003

2014 ◽  
Vol 166 (3) ◽  
pp. 421-424 ◽  
Author(s):  
Katharine Patrick ◽  
Rachel Wade ◽  
Nick Goulden ◽  
Chris Mitchell ◽  
Anthony V. Moorman ◽  
...  
Keyword(s):  
T Cell ◽  
Young People ◽  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Cell Precursor ◽  
Children And Young People
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