Acute lymphoblastic leukemia in adolescents and young adults in Finland

Usvasalo, Anu; Räty, Riikka; Knuutila, Sakari; Vettenranta, Kim; Harila‐Saari, Arja; Jantunen, Esa; Kauppila, Marjut; Koistinen, Pirjo; Parto, Katriina; Riikonen, Pekka; Salmi, Toivo T.; Silvennoinen, Raija; Elonen, Erkki; Saarinen‐Pihkala, Ulla M.

doi:10.3324/haematol.12466

Cited by 79 publications

(29 citation statements)

References 226 publications

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“…Hunger et al 18 emphasized that adolescents/young adults with ALL should be referred to pediatric treatment centers and, wherever appropriate, enrolled in pediatric trials. By contrast, a Finnish study 20 reported similar outcomes for pediatric and adult protocols, and suggested that pediatric and adult protocols were fairly similar. In Finland, adults and children with ALL are treated in one of five academic centers, Proportion of cured cases (%) 1982-1984 1985-1987 1988-1990 1991-1993 1994-1996 1997-1999 2000-2002 Period of diagnosis and there is high adherence to protocols.…”

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confidence: 73%

“…In Finland, adults and children with ALL are treated in one of five academic centers, Proportion of cured cases (%) 1982-1984 1985-1987 1988-1990 1991-1993 1994-1996 1997-1999 2000-2002 Period of diagnosis and there is high adherence to protocols. 20 Cancer biology might also contribute to the modest increase in proportion of adolescents/young adults cured over the study period. Compared to children, adolescents/young adults with ALL are more likely to have adverse biological characteristics, such as pro-T cell immunophenotype and the t(9,22) BCR-ABL (Philadelphia chromosome) translocation.…”

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confidence: 99%

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Survival and cure trends for European children, adolescents and young adults diagnosed with acute lymphoblastic leukemia from 1982 to 2002

Gatta

Rossi²,

Foschi

et al. 2013

Haematologica

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Proportion cured is a potentially more informative cancer outcome measurement than 5-year survival. We present population-based estimates of cure for young patients diagnosed with acute lymphoblastic leukemia in Europe from 1982 to 2002. Thirty-five European cancer registries provided data. Survival was estimated by age, period of diagnosis and European region, and used as input for parametric cure models, which assume cured patients have the same mortality as the general population. For acute lymphoblastic leukemia diagnosed in 1-14 year olds in 2000-2002, over 77% were estimated cured. The proportion cured improved significantly over the study period: an impressive 26-58% in infants (up to 1 year), 70-90% in 1-4 year olds, 63-86% in 5-9 year olds, 52-77% in 10-14 year olds, and 44-50% in 15-24 year olds. Regional variations in proportion cured reduced over time for 1-14 year-olds, but persisted in infants and 15-24 year olds. Five-year survival was always slightly higher than proportion cured. Considerable proportions of young patients were estimated cured of acute lymphoblastic leukemia. Nevertheless, a small excess risk of death persisted beyond five years after diagnosis when patients remained at risk for late treatment effects, late relapses and second primaries

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confidence: 73%

mentioning

confidence: 99%

Survival and cure trends for European children, adolescents and young adults diagnosed with acute lymphoblastic leukemia from 1982 to 2002

Gatta

Rossi²,

Foschi

et al. 2013

Haematologica

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“…In this study, 45 a group of 128 patients from 10 to 16 years of age (median age, 12.9 years) treated on pediatric protocols were compared with 97 patients 17 to 25 years of age (median age, 18.9 years). Despite the significant difference in median age and some differences in drug schedule and dosing between the two groups, there was no significant difference in the 5-year EFS (67% for the pediatric group and 60% for the adult group) or OS (77% in the pediatric group and 70% for the adult group).…”

Section: Retrospective Comparison Of Pediatric and Adult Cooperative mentioning

confidence: 99%

Adolescents and Young Adults with Acute Lymphoblastic Leukemia

Stock

2010

Hematology

108

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During the last decade, increasing attention has been paid to a unique group of patients with acute lymphoblastic leukemia (ALL) who lie at the crossroad of therapeutic care by pediatric and adult hematologists/oncologists. ALL is a disease that affects infants, children, adolescents, and adult patients. With current therapies, the vast majority of children with ALL are now long-term survivors; unfortunately, the same good results have not yet been obtained for adults with ALL. This review will describe current controversies surrounding the treatment of adolescents and young adults with ALL-a group who finds themselves in the transition from "pediatric" to "adult" treatment approaches. The review focuses on recent insights into disease biology, prognostic factors, and treatment outcomes that have led to a series of prospective clinical trials specifically designed for adolescents and younger adults (AYAs) with ALL. These trials have been designed to provide important new clinical, psychosocial, and biological insights, and to further improve the survival of this challenging and unique group of patients.

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“…44 Finally, experience gained in the management of childhood ALL is being transferred not only to adolescents, traditionally also cared for in adult hematology units, but also to young adults, in whom strategies used for childhood ALL have already proven to be largely of benefit, although not in all settings. 45,46 Monoclonal antibodies against specific epitopes of ALL blasts have been repeatedly tested but, thus far, none has become widely used in childhood ALL. Finally, studies of gene expression profiles and microRNA, are expected to improve the classification of ALL and possibly indicate treatment modifications.…”

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confidence: 99%

Treatment of pediatric acute lymphoblastic leukemia

Tucci¹

2008

Haematologica

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F e r r a t a S t o r t i F o u n d a t i o n © F e r r a t a S t o r t i F o u n d a t i o nEditorialsthe cases, had an excellent outcome with over 90% surviving at 4 years.14 One main next step for evaluation is the achievement of morphological remission by the end of induction therapy, usually between day 28 and 42. It is well known that patients failing to have <5% blasts in the bone marrow, as assessed by morphology, have a dismal prognosis, although many of them may have a chance to achieve morphological remission by subsequent chemotherapy, thus opening the way to alternative modalities of consolidation.During the last decade, measurement of blast reduction during the first weeks became a relevant issue. Morphological evaluation is not sufficiently accurate for this purpose and methods aimed at detecting of limited numbers of blast cells (minimal residual disease) in the bone marrow, or even in the peripheral blood, have been explored. Such methods may provide the advantage of an early information allowing significant modifications of the treatment schedule according to the prognostic indications. Both flow cytometry and polymerase chain reaction (PCR) analysis have been used for the detection of minimal residual disease. Patients with leukemic blast concentrations below 0.01% by the end of induction therapy have a good prognosis because of their low risk of relapse. Contrariwise, when the concentration of leukemic blasts is 10% on day 15, or 1% by the end of induction therapy or later on, the risk of leukemia relapse is very high. [15][16] PCR analysis is a very sensitive method for identifying very low risk patients, although it is very expensive and time-consuming, and up to 20% of patients may be ineligible for technical reasons by the more stringent protocols of analysis. Its extensive use in the AIEOP-BFM-ALL 2000 stydy recently provided evidence that PCR analysis can discriminate patients with different prognoses even within groups defined as non-high risk by traditional criteria.17 Flow cytometry appears a very promising technique for the detection of minimal residual disease, is relatively cheap and almost all patients can be studied within hours. Its extensive clinical use by the St. Jude Children's Research Hospital in Memphis demonstrated its feasibility in a single, large institution. More recently, two large co-operative studies have confirmed the feasibility of this method in children with ALL. 18-20 Front-line treatment of childhood acute lymphoblastic leukemiaWith the only exception of patients with mature Bcell ALL, for whom a specific short and very intense chemotherapy program has been developed by most groups, all patients with childhood ALL are treated according to a similar strategy. Front-line therapy consists of several phases, with different aims; initial induction (of the first remission) therapy is delivered over 4-5 weeks; central nervous system (CNS)-directed therapy is administered to prevent meningeal progression or relapse; intensive post-remission chemotherapy is aimed at...

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Acute lymphoblastic leukemia in adolescents and young adults in Finland

Cited by 79 publications

References 226 publications

Survival and cure trends for European children, adolescents and young adults diagnosed with acute lymphoblastic leukemia from 1982 to 2002

Survival and cure trends for European children, adolescents and young adults diagnosed with acute lymphoblastic leukemia from 1982 to 2002

Adolescents and Young Adults with Acute Lymphoblastic Leukemia

Treatment of pediatric acute lymphoblastic leukemia

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