Five-year survival rate for children with acute lymphatic leukemia

 In the Netherlands, the most frequent kind of pediatric cancer is acute lymphatic leukemia. Each year, around 110 children are diagnosed with this kind of cancer. The prognosis is bright for many children, but not for all. To enhance survival rates and quality of life for all children with leukemia, the treatment strategy is continually being revised based on new scientific discoveries.

The study results of the ALL-11 treatment protocol, led by researchers at the Princess Máxima Center, were published in the scientific journal Journal of Clinical Oncology.

The five-year survival rate for all children with acute lymphatic leukemia (ALL) has risen to 94 per cent. A study of 800 Dutch youngsters demonstrates this. Modified treatment procedures for four subgroups were investigated in the research. The changes were discovered to have a favourable impact on survival and quality of life.

For example, the risk of disease recurrence became as much as three times smaller for children with an aggressive form of leukemia. Said Prof. Dr. Rob Pieters: ‘The five-year survival rate for children with acute lymphatic leukemia has increased dramatically since the 1960s, from zero to 94 per cent, but the last steps are the most difficult.’

Between April 2012 and July 2020, more than 800 children in the Netherlands were treated according to this protocol. The study looked at the effect of modified treatment in specific groups of children with leukemia, including those with a so-called Ikaros abnormality. Prof. Dr. Rob Pieters, pediatric oncologist and medical director of the Princess Máxima Center, led the clinical study. He says: ‘There is broad interest worldwide in this research, because it was still unknown how to improve therapy for children with Ikaros leukemia.’

Children with an Ikaros abnormality in the DNA of their leukemia cells are more likely to have their disease return after treatment. In this study, these children received an additional year of ‘maintenance phase’ chemotherapy on top of the first two years of treatment. This modification led to a three times lower risk of the cancer returning: it only happened in 9% of them, compared to 26% of children in the previous treatment protocol.

In the ALL-11 protocol, doctors and researchers also looked at the effect of less intensive treatment for three other groups of children. These included children with a DNA abnormality in their leukemia cells that is associated with a very high cure rate, and children with Down syndrome who suffer a lot of side effects from therapy. These children were given lower amounts of anthracyclines, a particular type of chemotherapy that increases the risk of heart damage and infections. The modification turned out to be a good choice: the children had the same or even better survival rate while their quality of life improved due to a lower risk of infections and less risk of heart damage.

Prof. Dr. Rob Pieters: ‘The five-year survival rate for children with acute lymphoblastic leukemia has increased tremendously since the 1960s, from zero to 94%, but the last steps are the hardest. We are now one step closer to curing all children with ALL. We have also been able to remove a drug that gives risk of heart damage largely from the treatment of children with less aggressive disease. So the latest results for children with leukemia fit exactly with our mission: more cure, with fewer side effects.'