Adolescents with acute lymphatic leukaemia achieve significantly better results when treated following Dutch paediatric oncology protocols than with adult protocols

Objective. To compare the results, in adolescents with acute lymphatic leukaemia (ALL), of treatment according to the protocols of the Netherlands Foundation for Paediatric Oncology (DCOG) or according to the protocols for adults of the Dutch Foundation for Adult Haemato-Oncology (HOVON). Design. Retrospective. Method. During the period from May I985 to November I999, I20 I5-20-year-old adolescents with ALL were treated: 47 according to a DCOG protocol and 73 according to a HOVON protocol. The records of the integrated cancer centres indicate that this represented about two-thirds of all known adolescents with ALL in the Netherlands. Results. Adolescents with ALL treated according to the DCOG protocols had significantly better 5-year survival rates (79% versus 38%), a significantly lower probability of relapse (27% versus 55%) and a lower treatment-related mortality (4% versus 25%) than the adolescents treated according to the HOVON protocols. Conclusion. This difference in outcome was most likely related to differences in structure and content between the DCOG and HOVON protocols. The HOVON protocols consisted of relatively short, intensive chemotherapy, often followed by autologous or allogeneic bone-marrow transplantation. Several treatment elements present in the DCOG protocols, such as high-dose methotrexate, reinduction therapy and maintenance therapy were absent in the HOVON protocols. Moreover, the cumulative dosages of dexamethasone, mercaptopurine, asparaginase and vincristine were lower in the HOVON protocols.