Long-term results of Taiwan Pediatric Oncology Group studies 1997 and 2002 for childhood acute lymphoblastic leukemia

D. C. Liang, C. P. Yang, D. T. Lin, I. J. Hung, K. H. Lin, J. S. Chen, C. C. Hsiao, T. T. Chang, C. T. Peng, M. T. Lin, T. K. Chang, T. H. Jaing, H. C. Liu, L. Y. Wang, T. C. Yeh, S. T. Jou, M. Y. Lu, C. N. Cheng, J. M. Sheen, S. S. ChiouK. H. Wu, G. Y. Hung, R. L. Chen, S. H. Chen, S. N. Cheng, Y. H. Chang, B. W. Chen, W. L. Ho, J. L. Wang, S. T. Lin, Y. L. Hsieh, S. C. Wang, H. H. Chang, Y. L. Yang, F. L. Huang, C. Y. Chang, W. H. Chang, K. S. Lin

Research output: Contribution to journalArticle

58 Citations (Scopus)

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 (P0.0004) over this period, 69.31.9% in 1997-2001 to 77.41.7% 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.

Original languageEnglish
Pages (from-to)397-405
Number of pages9
JournalLeukemia
Volume24
Issue number2
DOIs
Publication statusPublished - Feb 2010
Externally publishedYes

Fingerprint

Taiwan
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pediatrics
Cranial Irradiation
Polyploidy
Leukocyte Count
Biphenotypic Acute Leukemia
Clinical Trials
Remission Induction
Asparaginase
Second Primary Neoplasms
Vincristine
Etoposide
Prednisolone
Disease-Free Survival
Multivariate Analysis
Quality of Life
Recurrence
Incidence

Keywords

  • Acute lymphoblastic leukemia
  • Children
  • Treatment results

ASJC Scopus subject areas

  • Hematology
  • Cancer Research
  • Anesthesiology and Pain Medicine

Cite this

Liang, D. C., Yang, C. P., Lin, D. T., Hung, I. J., Lin, K. H., Chen, J. S., ... Lin, K. S. (2010). Long-term results of Taiwan Pediatric Oncology Group studies 1997 and 2002 for childhood acute lymphoblastic leukemia. Leukemia, 24(2), 397-405. https://doi.org/10.1038/leu.2009.248

Long-term results of Taiwan Pediatric Oncology Group studies 1997 and 2002 for childhood acute lymphoblastic leukemia. / Liang, D. C.; Yang, C. P.; Lin, D. T.; Hung, I. J.; Lin, K. H.; Chen, J. S.; Hsiao, C. C.; Chang, T. T.; Peng, C. T.; Lin, M. T.; Chang, T. K.; Jaing, T. H.; Liu, H. C.; Wang, L. Y.; Yeh, T. C.; Jou, S. T.; Lu, M. Y.; Cheng, C. N.; Sheen, J. M.; Chiou, S. S.; Wu, K. H.; Hung, G. Y.; Chen, R. L.; Chen, S. H.; Cheng, S. N.; Chang, Y. H.; Chen, B. W.; Ho, W. L.; Wang, J. L.; Lin, S. T.; Hsieh, Y. L.; Wang, S. C.; Chang, H. H.; Yang, Y. L.; Huang, F. L.; Chang, C. Y.; Chang, W. H.; Lin, K. S.

In: Leukemia, Vol. 24, No. 2, 02.2010, p. 397-405.

Research output: Contribution to journalArticle

Liang, DC, Yang, CP, Lin, DT, Hung, IJ, Lin, KH, Chen, JS, Hsiao, CC, Chang, TT, Peng, CT, Lin, MT, Chang, TK, Jaing, TH, Liu, HC, Wang, LY, Yeh, TC, Jou, ST, Lu, MY, Cheng, CN, Sheen, JM, Chiou, SS, Wu, KH, Hung, GY, Chen, RL, Chen, SH, Cheng, SN, Chang, YH, Chen, BW, Ho, WL, Wang, JL, Lin, ST, Hsieh, YL, Wang, SC, Chang, HH, Yang, YL, Huang, FL, Chang, CY, Chang, WH & Lin, KS 2010, 'Long-term results of Taiwan Pediatric Oncology Group studies 1997 and 2002 for childhood acute lymphoblastic leukemia', Leukemia, vol. 24, no. 2, pp. 397-405. https://doi.org/10.1038/leu.2009.248
Liang, D. C. ; Yang, C. P. ; Lin, D. T. ; Hung, I. J. ; Lin, K. H. ; Chen, J. S. ; Hsiao, C. C. ; Chang, T. T. ; Peng, C. T. ; Lin, M. T. ; Chang, T. K. ; Jaing, T. H. ; Liu, H. C. ; Wang, L. Y. ; Yeh, T. C. ; Jou, S. T. ; Lu, M. Y. ; Cheng, C. N. ; Sheen, J. M. ; Chiou, S. S. ; Wu, K. H. ; Hung, G. Y. ; Chen, R. L. ; Chen, S. H. ; Cheng, S. N. ; Chang, Y. H. ; Chen, B. W. ; Ho, W. L. ; Wang, J. L. ; Lin, S. T. ; Hsieh, Y. L. ; Wang, S. C. ; Chang, H. H. ; Yang, Y. L. ; Huang, F. L. ; Chang, C. Y. ; Chang, W. H. ; Lin, K. S. / Long-term results of Taiwan Pediatric Oncology Group studies 1997 and 2002 for childhood acute lymphoblastic leukemia. In: Leukemia. 2010 ; Vol. 24, No. 2. pp. 397-405.
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T1 - Long-term results of Taiwan Pediatric Oncology Group studies 1997 and 2002 for childhood acute lymphoblastic leukemia

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AU - Lin, D. T.

AU - Hung, I. J.

AU - Lin, K. H.

AU - Chen, J. S.

AU - Hsiao, C. C.

AU - Chang, T. T.

AU - Peng, C. T.

AU - Lin, M. T.

AU - Chang, T. K.

AU - Jaing, T. H.

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AU - Wang, L. Y.

AU - Yeh, T. C.

AU - Jou, S. T.

AU - Lu, M. Y.

AU - Cheng, C. N.

AU - Sheen, J. M.

AU - Chiou, S. S.

AU - Wu, K. H.

AU - Hung, G. Y.

AU - Chen, R. L.

AU - Chen, S. H.

AU - Cheng, S. N.

AU - Chang, Y. H.

AU - Chen, B. W.

AU - Ho, W. L.

AU - Wang, J. L.

AU - Lin, S. T.

AU - Hsieh, Y. L.

AU - Wang, S. C.

AU - Chang, H. H.

AU - Yang, Y. L.

AU - Huang, F. L.

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N2 - 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 (P0.0004) over this period, 69.31.9% in 1997-2001 to 77.41.7% 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.

AB - 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 (P0.0004) over this period, 69.31.9% in 1997-2001 to 77.41.7% 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.

KW - Acute lymphoblastic leukemia

KW - Children

KW - Treatment results

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