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Acute lymphoblastic leukemia in adolescents and young adults in Finland

¹ Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki
² Department of Hematology, Helsinki University Central Hospital, Helsinki
³ Department of Pathology, Haartman Institute and HUSLAB, University of Helsinki and Helsinki University Central Hospital, Helsinki
⁴ Departments of Pediatrics
⁵ Internal Medicine, Oulu University Hospital, Oulu
⁶ Departments of Medicine
⁷ Pediatrics, Kuopio University Hospital, Kuopio
⁸ Departments of Medicine
⁹ Pediatrics, Turku University Central Hospital, Turku
¹⁰ Departments of Pediatrics
¹¹ Internal Medicine, Tampere University Hospital, Tampere, Finland

Correspondence: Anu Usvasalo, MD, Hospital for Children and Adolescents, University of Helsinki, P.O. Box 281, 00029 HUS, Helsinki, Finland. E-mail:anu.usvasalo{at}helsinki.fi

Background: Interest has recently been paid to adolescents and young adults with acute lymphoblastic leukemia, particularly because all reports so far published indicate that these patients have a better outcome when treated with pediatric rather than adult therapeutic protocols. There are different biological subtypes of acute lymphoblastic leukemia with distinct features and prognoses; the distribution of these subtypes is not well known among adolescents. We, therefore, studied acute lymphoblastic leukemia in adolescents and young adults aged 10 to 25 years in Finland.

Design and Methods: This population-based study included 225 consecutive patients aged 10–25 years diagnosed with acute lymphoblastic leukemia during 1990–2004. One hundred and twenty-eight patients (10–16 years) were treated with pediatric Nordic (NOPHO) protocols, and 97 patients (17–25 years) with Finnish Leukemia Group National protocols. We characterized the biological subtypes, clinical features and outcome of these patients.

Results: For the whole cohort, the remission rate was 96%, 5-year event-free survival 62% and overall survival 72%.The 5-year event-free survival was 67% for the pediatric treatment group and 60% for the adult treatment group (p=n.s.). Patients with inferior outcome were those with a white bood cell count 100x10⁹/L, the Philadelphia chromosome and MLL. Good prognostic features were TEL-AML1, hyperdiploidy, and pediatric intermediate risk stratification.

Conclusions: Unlike all previous studies, we found that the outcome of adolescents and young adults with acute lymphoblastic leukemia treated with pediatric or adult therapeutic protocols was comparable. The success of the adult acute lymphoblastic leukemia therapy emphasizes the benefit of central referral of patients to academic centers and adherence to research protocols. Key words: acute lymphoblastic leukemia, adolescents, survival, treatment outcome, young adults.

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Haematologica 2008 93: 1124-1128. [Full Text] [PDF]