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Infectious Complications During Early Treatment of Childhood Acute Lymphoblastic Leukemia—A Comparison Between the ALLTogether and NOPHO ALL-2008 Protocols

van Bunningen, Hannah ; Fermér, Johannes ; Harila, Arja ; Ranta, Susanna ; Donnér, Isabella ; Wretman, Anne ; Vogt, Hartmut ; Holmqvist, Anna Sällfors LU ; Valind, Anders LU orcid and Henriksson, Ludvig , et al. (2026) In Pediatric Blood and Cancer 73(1).
Abstract

Introduction: Infection remains the most common treatment-related toxicity of childhood ALL, emphasizing the need to identify patients at risk and to tailor treatment strategies accordingly. Aims: The primary aim was to compare infectious toxicity during early treatment for childhood ALL following the ALLTogether and NOPHO ALL-2008 (ALL-2008) protocols, and second, to identify risk factors for infectious toxicity. Methods: A national retrospective matched cohort study was conducted, including 345 patients aged 1–17 years diagnosed with ALL and treated in Sweden according to the ALLTogether or ALL-2008 protocols. Nonparametric tests were used to compare infectious outcomes between protocols, and regression modeling was used to identify... (More)

Introduction: Infection remains the most common treatment-related toxicity of childhood ALL, emphasizing the need to identify patients at risk and to tailor treatment strategies accordingly. Aims: The primary aim was to compare infectious toxicity during early treatment for childhood ALL following the ALLTogether and NOPHO ALL-2008 (ALL-2008) protocols, and second, to identify risk factors for infectious toxicity. Methods: A national retrospective matched cohort study was conducted, including 345 patients aged 1–17 years diagnosed with ALL and treated in Sweden according to the ALLTogether or ALL-2008 protocols. Nonparametric tests were used to compare infectious outcomes between protocols, and regression modeling was used to identify risk factors of the infectious outcomes. Results: Treatment following ALL-2008 showed higher infectious toxicity during induction, whereas treatment following ALLTogether showed increased infectious toxicity during consolidation 1. Overall, treatment according to ALL-2008 was associated with a higher incidence of infections. Anthracycline use and young age (1–9 years) were associated with both higher infectious incidence and more severe infectious complications. Dexamethasone was associated with both lower incidence and lower severity of infectious complications as compared to prednisone. Conclusions: A notable shift in the timing of infectious toxicity was observed between the two treatment protocols. Risk factors for infectious toxicity during early treatment include anthracycline use and young age. Dexamethasone as an induction steroid was associated with lower infectious burden, although its effect is difficult to isolate from the simultaneous anthracycline effect. The findings suggest that treatment composition plays a central role in determining both the extent and timing of infectious complications.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute lymphoblastic leukemia, childhood, infection, pediatric, toxicity
in
Pediatric Blood and Cancer
volume
73
issue
1
article number
e32120
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:105019591013
  • pmid:41126485
ISSN
1545-5009
DOI
10.1002/pbc.32120
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). Pediatric Blood & Cancer published by Wiley Periodicals LLC.
id
defbaab1-442c-458d-be2d-6f7cac950522
date added to LUP
2026-01-16 15:36:12
date last changed
2026-01-16 15:36:51
@article{defbaab1-442c-458d-be2d-6f7cac950522,
  abstract     = {{<p>Introduction: Infection remains the most common treatment-related toxicity of childhood ALL, emphasizing the need to identify patients at risk and to tailor treatment strategies accordingly. Aims: The primary aim was to compare infectious toxicity during early treatment for childhood ALL following the ALLTogether and NOPHO ALL-2008 (ALL-2008) protocols, and second, to identify risk factors for infectious toxicity. Methods: A national retrospective matched cohort study was conducted, including 345 patients aged 1–17 years diagnosed with ALL and treated in Sweden according to the ALLTogether or ALL-2008 protocols. Nonparametric tests were used to compare infectious outcomes between protocols, and regression modeling was used to identify risk factors of the infectious outcomes. Results: Treatment following ALL-2008 showed higher infectious toxicity during induction, whereas treatment following ALLTogether showed increased infectious toxicity during consolidation 1. Overall, treatment according to ALL-2008 was associated with a higher incidence of infections. Anthracycline use and young age (1–9 years) were associated with both higher infectious incidence and more severe infectious complications. Dexamethasone was associated with both lower incidence and lower severity of infectious complications as compared to prednisone. Conclusions: A notable shift in the timing of infectious toxicity was observed between the two treatment protocols. Risk factors for infectious toxicity during early treatment include anthracycline use and young age. Dexamethasone as an induction steroid was associated with lower infectious burden, although its effect is difficult to isolate from the simultaneous anthracycline effect. The findings suggest that treatment composition plays a central role in determining both the extent and timing of infectious complications.</p>}},
  author       = {{van Bunningen, Hannah and Fermér, Johannes and Harila, Arja and Ranta, Susanna and Donnér, Isabella and Wretman, Anne and Vogt, Hartmut and Holmqvist, Anna Sällfors and Valind, Anders and Henriksson, Ludvig and Abrahamsson, Jonas and Borssén, Magnus and Nilsson, Anna and Heyman, Mats}},
  issn         = {{1545-5009}},
  keywords     = {{acute lymphoblastic leukemia; childhood; infection; pediatric; toxicity}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Pediatric Blood and Cancer}},
  title        = {{Infectious Complications During Early Treatment of Childhood Acute Lymphoblastic Leukemia—A Comparison Between the ALLTogether and NOPHO ALL-2008 Protocols}},
  url          = {{http://dx.doi.org/10.1002/pbc.32120}},
  doi          = {{10.1002/pbc.32120}},
  volume       = {{73}},
  year         = {{2026}},
}