Prevalence of early toxicities in pediatric ALL with the NOPHO ALL2008 vs ALLTogether protocol

Results from a retrospective, Swedish population-based cohort study comparing early treatment toxicity between the ALLTogether and NOPHO ALL2008 protocols in 117 and 234 children with acute lymphoblastic leukemia (ALL), respectively, were recently published in Pediatric Blood & Cancer by Fermér et al. 

Key data: While the mean number of toxicities per patient was similar between the ALLTogether and NOPHO ALL2008 protocols (2.5 vs 2.3, respectively), the ALLTogether cohort had significantly greater weight gain of more than 10% (55.6% vs 18.5%; p < 0.01), alongside higher rates of osteonecrosis (3.4% vs 0%; p = 0.012) and hyperglycemia (odds ratio [OR], 5.17) vs the NOPHO ALL2008 cohort. Liver dysfunction was less frequent with the ALLTogether protocol (OR, 0.59), while the number of inpatient days was comparable across protocols, with the exception of the initial hospitalization, which was longer in the ALLTogether cohort (median 11 vs 7 days; p < 0.01).  

Key learning: The earlier and prolonged administration of pegylated asparaginase and concomitant use of dexamethasone in the ALLTogether induction protocol likely contributed to increased hyperglycemia, osteonecrosis, and weight gain, representing a shift in toxicity profile despite similar overall toxicity burden.