Study Examines Impact of Modified Treatment Protocols on Survival in Pediatric Patients With ALL

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The 5-year survival rate of pediatric patients with acute lymphoblastic leukemia (ALL) has continued to increase to 94%, according to a new study published by Pieters et al in the Journal of Clinical Oncology.


ALL is the most common form of pediatric cancer in the Netherlands—with about 110 new diagnoses per year. Although the prognoses for these patients are mostly good, not every patient experiences positive outcomes. To improve survival rates and quality of life for all pediatric patients with ALL, physicians continue to revise the treatment protocol based on new scientific insights.

“The 5-year survival rate for children with [ALL] has increased dramatically since the 1960s, from 0% to 94%, but the last steps are the most difficult,” stressed lead study author Rob Pieters, MD, MSc, PhD, Professor of Pediatric Oncology at the University of Utrecht and Chief Medical Officer of the Princess Máxima Center for Pediatric Oncology.

Pediatric patients with an Ikaros abnormality in the DNA of their leukemia cells are more likely to experience cancer recurrence.

“There is broad interest worldwide in this research, because it was still unknown how to improve therapy for children with Ikaros leukemia,” Dr. Pieters explained.

Study Methods and Results

In the new study, investigators examined the efficacy of the modified ALL11 treatment protocol in four subgroups of over 819 pediatric patients from the Netherlands between April 2012 and July 2020.

The modifications were found to have positive effects on survival and quality of life. For instance, patients with an Ikaros abnormality received 1 additional year of maintenance chemotherapy on top of the first 2 years of treatment. This modification led to a threefold lower risk of cancer recurrence—where only 9% of patients saw their cancer return vs 26% of patients in the previous treatment protocol.

In the ALL11 protocol, the researchers also analyzed the effects of less intensive treatments for the other three groups of pediatric patients who participated in the study—including patients with a DNA abnormality in their leukemia cells associated with a high cure rate and those with Down syndrome who suffered greater adverse effects from therapy. The investigators assigned these patients to receive lower amounts of anthracyclines and found that they had similar or higher survival rates, an improved quality of life, and a lower risk of infections and reduced risk of heart damage.


“We are now one step closer to curing all [pediatric patients] with ALL. We have also been able to remove a drug that gives risk of heart damage largely from the treatment of [patients] with less aggressive disease. So, the latest results for [pediatric patients] with [ALL] fit exactly with our mission: more cure, with fewer side effects,” Dr. Pieters concluded.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.