• Kjeld Schmiegelow, Andishe Attarbaschi, Shlomit Barzilai, Gabriele Escherich, Thomas Leth Frandsen, Christina Halsey, Rachael Hough, Sima Jeha, Motohiro Kato, Der-Cherng Liang, Torben Stamm Mikkelsen, Anja Möricke, Riitta Niinimäki, Caroline Piette, Maria Caterina Putti, Elizabeth Raetz, Lewis B Silverman, Roderick Skinner, Ruta Tuckuviene, Inge van der Sluis, Ester Zapotocka, and Ponte di Legno toxicity working group.
• Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Pediatric Oncology, Langone Medical Center, New York University, New York, NY, USA. Electronic address: kschmiegelow@rh.dk.
• Lancet Oncol. 2016 Jun 1; 17 (6): e231-e239.

AbstractAlthough there are high survival rates for children with acute lymphoblastic leukaemia, their outcome is often counterbalanced by the burden of toxic effects. This is because reported frequencies vary widely across studies, partly because of diverse definitions of toxic effects. Using the Delphi method, 15 international childhood acute lymphoblastic leukaemia study groups assessed acute lymphoblastic leukaemia protocols to address toxic effects that were to be considered by the Ponte di Legno working group. 14 acute toxic effects (hypersensitivity to asparaginase, hyperlipidaemia, osteonecrosis, asparaginase-associated pancreatitis, arterial hypertension, posterior reversible encephalopathy syndrome, seizures, depressed level of consciousness, methotrexate-related stroke-like syndrome, peripheral neuropathy, high-dose methotrexate-related nephrotoxicity, sinusoidal obstructive syndrome, thromboembolism, and Pneumocystis jirovecii pneumonia) that are serious but too rare to be addressed comprehensively within any single group, or are deemed to need consensus definitions for reliable incidence comparisons, were selected for assessment. Our results showed that none of the protocols addressed all 14 toxic effects, that no two protocols shared identical definitions of all toxic effects, and that no toxic effect definition was shared by all protocols. Using the Delphi method over three face-to-face plenary meetings, consensus definitions were obtained for all 14 toxic effects. In the overall assessment of outcome of acute lymphoblastic leukaemia treatment, these expert opinion-based definitions will allow reliable comparisons of frequencies and severities of acute toxic effects across treatment protocols, and facilitate international research on cause, guidelines for treatment adaptation, preventive strategies, and development of consensus algorithms for reporting on acute lymphoblastic leukaemia treatment.Copyright © 2016 Elsevier Ltd. All rights reserved.

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