Intensive Protocol Improves Survival for Adults with Acute Lymphoblastic Leukemia

Intensive Protocol Improves Survival for Adults with Acute Lymphoblastic Leukemia
Intensive Protocol Improves Survival for Adults with Acute Lymphoblastic Leukemia

Event-free survival for adult patients with acute lymphoblastic leukemia (ALL) has improved from 40% to 73% with the implementation of the Nordic Society for Pediatric Hematology and Oncology (NOPHO) ALL 2008 protocol in July 2008. These findings were presented at the European Hematology Association 21st Congress.1,2

Historically, survival rates for patients age 18 to 45 years with ALL are approximately 40%. However, with the NOPHO ALL 2008 protocol, event-free survival in these patients improved to 73%.

NOPHO ALL 2008 is an intensive protocol that divides patients into 4 risk groups — standard, intermediate, high, and high risk + hematopoietic stem cell transplantation — based on immunophenotype, white blood cell count greater than 100 for B-cell ALL at diagnosis, minimal residual disease at days 29 and 79, and the presence of intermediate-risk [dic(9:20 or iAMP21[RUNX1] or t(1;19)] or high-risk cytogenetics [KMT2A-r or hypodiploidy (modal number <45)]. The protocol is used to manage the treatment of ALL in patients age 1 to 45 years in Denmark, Estonia, Finland, Iceland, Lithuania, Norway, and Sweden.

This study analyzed 1509 patients with ALL, including 221 adults age 18 to 45 years. The study found that adult patients are more often at higher risk than children. Furthermore, adult patients tolerate intensive chemotherapy almost as well as children and are not subject to delays or gaps during treatment. Finally, comparisons within the 4 risk groups show survival rates for adults is close to that for children, and survival is markedly improved since the protocol was implemented in 2008.


1. Toft N, Birgens H, Abrahamsson J, et al. Adults and children (1-45 years) with Ph-negative ALL have almost identical outcome in risk-stratified analysis of NOPHO ALL2008. Presentation at: European Hematology Association 21st Congress; June 9-12, 2016; Copenhagen, Denmark. Abstract LB173.

2. The 2008 NOPHO Protocol has improved survival for adults with acute lymphoblastic leukemia [news release]. PracticeUpdate web site. June 13, 2016. Accessed June 24, 2016.
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