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In a multinational, population-based study from the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden), 2648 children below 15 y of age were diagnosed with acute lymphoblastic leukaemia (ALL) in the years 1981-1996. The annual incidence was 3.9/100 000 children and was stable throughout the study period. The development from regional or national protocols to common Nordic treatment protocols for all risk groups was completed in 1992 through a successive intensification of therapy, based on multidrug chemotherapy including pulses of methotrexate in high doses and avoidance of cranial irradiation in most children. For children with non-B-cell ALL (n o 2602), the event-free survival (p-EFS) increased from 0.53 6 0.02 (diagnosed 7/81-6/86) to 0.67 6 0.02 (7/86-12/91) to 0.78 6 0.02 (1/92-12/96). The corresponding p-EFS values at 5 y were 0.57, 0.70 and 0.78, respectively. The main improvements were seen in the group of children with non-high risk leukaemia, with 5-y p-EFS values increasing from 0.60 to 0.76 and 0.85 for the three periods. In high-risk patients, progress has been moderate, especially in children with high white blood cell values at diagnosis. During the last 5-y period, only 10% of the patients received cranial irradiation in first remission while 90% of the patients received high doses of cytostatic infusions (methotrexate isolated or combined with cytarabinoside) and multiple intrathecal injections of methotrexate as CNS-adjusted treatment without any indication of an increased CNS relapse rate. ' Childhood acute lymphoblastic leukaemia, incidence, prognosis in childhood acute lymphoblastic leukaemia, prognostic factors, treatment results

Some attempts have been made to reduce the costs incurred in the therapy of leukaemia, but no studies are available regarding costs of the entire treatment in children with acute lymphocytic leukaemia (ALL). We analysed all the direct costs of treatment of 11 children with ALL diagnosed and treated in Kuopio University Hospital. The follow-up continued from diagnosis until the end of treatment for each patient. Patient treatment on the ward lasted for 84-210 d and in the outpatient clinic for 24-66 d, depending on the risk group. From 11-54 of the inpatient days were required for the treatment of infections. Total mean cost of the entire treatment was US $103250 (US $55196-166039) per patient, 53% of which were basic hospital costs and 47% patient-specific costs. Laboratory tests and radiology accounted for 18% of all direct costs and cytostatic drugs for 13%, but blood products accounted for only 4% of the total. Infections were the most important extra cause of costs, accounting for 18% of the mean total costs per patient. The complete treatment of a child with ALL came to a total of US $103250. However, since 80% of children with ALL are long-term survivors, the cost must be regarded as a good investment.

Nine children with acute lymphoblastic leukemia in remission were studied at the end of their three years' maintenance therapy. In the jejunal biopsy specimens significantly fewer intraepithelial lymphocytes and IgA-cells were observed in the patients than in the controls. However, the crypts were deeper than normal, and the mitotic activity of the crypt cells was markedly increased in all of the patients. Three children presented with decreased epithelial disaccharidase activities. One had abnormal D-xylose test and two abnormal lactose tolerance test. Although weight gain did not differ from the normal, height increase was retarded in all but one of the patients. We conclude that leukemia treatment leads to changes in the intestinal mucosa that might in part contribute to impairment of growth in the patients and to suppression of mucosal immunity in their jejunum.