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Relapse constitutes the greatest threat to event-free survival after completion of treatment for childhood acute lymphoblastic leukaemia (ALL). However, evidence on optimal follow-up schedules is limited. The aims of the present population-based cohort study were to assess the value of current follow-up schedules after completion of Nordic Society of Paediatric Haematology and Oncology ALL protocol treatment and to estimate the impact of relapse detection mode on overall survival (OS). Among 3262 patients diagnosed between 1992 and 2014 and who completed treatment, 338 developed a relapse. Relapse detection was equally distributed between extra visits (50·8%) and scheduled follow-up visits (49·2%). All cases detected at an extra visit and 64·3% of cases detected at a scheduled visit presented with symptoms or objective findings. Neither the mode of detection {adjusted hazard ratio 0·95, [95% confidence interval (CI) 0·61-1·48] for scheduled visits} nor the duration of symptoms was an independent risk factor for OS after relapse. The estimated number of scheduled blood samples needed to diagnose one subclinical relapse during the first 5 years after treatment cessation was 1269 (95% CI 902-1637). In conclusion, based on OS data, scheduled visits after cessation of therapy seem to yield no extra benefit. These results should frame future follow-up strategies.

Acute lymphoblastic leukaemia (ALL) has a high survival rate, but treatment is lengthy with risk of severe side-effects, which may also impact parents' health-related quality of life (HRQOL). We present data on 526 parents of 310 children treated for ALL according to the NOPHO ALL2008-protocol, in Sweden, Finland and Denmark. Parents were asked to complete the 36-Item Short Form Survey (SF-36) at least 6 months after end of treatment and data were compared with Norwegian reference data. Parental background factors were collected via a study-specific questionnaire. Participating parents scored significantly lower than the reference population on both physical and mental summary indexes, but only surpassed a minimal clinically important difference for the mental summary index (Mental Component Summary [MCS]). Mothers scored lower than fathers in the MCS and stopped working and took care of the affected child more often than the fathers. Higher mental HRQOL was associated with male gender and living in Finland or Denmark (compared to Sweden). Correlations within spouses in physical and mental scores were weak to moderate. In conclusion, ALL negatively affects parental HRQOL, especially the mental domains, even after treatment. Findings suggest that mothers are more affected than fathers and may require extra support.

SummaryL-asparaginase is an important drug in the treatment of childhood acutelymphoblastic leukaemia (ALL). Treatment is associated with several toxici-ties, including acute pancreatitis. Clinical course, presentation, re-exposureto L-asparginase after pancreatitis and risk of recurrent pancreatitis withinan asparaginase-intensive protocol has been poorly reported. Children (1–17 years) on the ongoing Nordic Society of Paediatric Haematology andOncology (NOPHO) ALL2008 protocol with asparaginase-associated pan-creatitis (AAP) diagnosed between 2008 and 2012 were identified throughthe online NOPHO ALL toxicity registry. NOPHO ALL2008 includes eightor 15 doses of intramuscular pegylated L-asparginase (PEG-asparaginase)1000 iu/m 2 /dose at 2–6 weeks intervals, with a total of 30 weeks of expo-sure to PEG-asparaginase (clinicaltrials.gov no: NCT00819351). Of 786children, 45 were diagnosed with AAP with a cumulative risk of AAP of5 9%. AAP occurred after a median of five doses (range 1–13), and 11 d(median) from the latest administration of PEG-Asparaginase. Thirteenpatients developed pseudocysts (30%) and 11 patients developed necrosis(25%). One patient died from pancreatitis. Twelve AAP patients werere-exposed to L-asparginase, two of whom developed mild AAP once more,after four and six doses respectively. In conclusion, re-exposure to PEG-asparaginase in ALL patients with mild AAP seems safe.Keywords: L-asparaginase, leukaemia, pancreatitis, toxicity, risk factors.