{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T03:30:55Z","timestamp":1786505455419,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100011727","name":"Stockholm l\u00e4ns landsting","doi-asserted-by":"publisher","award":["RS 2023\u20100869"],"award-info":[{"award-number":["RS 2023\u20100869"]}],"id":[{"id":"10.13039\/501100011727","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","award":["FS\u20102024:0017"],"award-info":[{"award-number":["FS\u20102024:0017"]}],"id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014688","name":"Region Uppsala","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014688","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Central nervous system (CNS) involvement and relapse remains a clinical challenge in the management of acute lymphoblastic leukaemia (ALL), and studies among adult ALL patients are scarce. We identified all adult ALL patients in Sweden between 2007 and 2022 (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009838) from the population\u2010based ALL register and evaluated factors associated with CNS involvement and relapse. CNS involvement at diagnosis was detected in 7.8% of patients, more often in patients with T\u2010cell ALL (T\u2010ALL) and with white blood cell (WBC) count &gt;30\u2009\u00d7\u200910\n                    <jats:sup>9<\/jats:sup>\n                    \/L, without affecting overall survival or risk of any relapse. The 5\u2010year cumulative incidence of CNS relapse was 4.6% (95% confidence interval [CI] 3.1\u20136.6), with WBC count &gt;100\u2009\u00d7\u200910\n                    <jats:sup>9<\/jats:sup>\n                    \/L and male sex as independent risk factors. Furthermore, CNS involvement at diagnosis increased the rate of CNS relapse in B\u2010cell ALL (B\u2010ALL) (hazard ratio [HR] 4.52, 95% CI 1.35\u201315.2), but not T\u2010ALL (HR 0.94, 95% CI 0.12\u20137.53). Neither Philadelphia chromosome status nor\n                    <jats:italic>KMT2A::AFF1<\/jats:italic>\n                    was associated with CNS involvement at diagnosis or CNS relapse. Patients with CNS relapse had a 2\u2010year overall survival of 34% (13% if relapse occurred &lt;12\u2009months from diagnosis). We conclude that contemporary treatment protocols can prevent CNS relapse for most patients but suggest that B\u2010ALL patients with CNS involvement may have an unmet need for improved CNS\u2010directed therapy.\n                  <\/jats:p>","DOI":"10.1111\/bjh.70589","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T12:41:12Z","timestamp":1780317672000},"page":"589-600","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>Central nervous system<\/scp>\n                    involvement and relapse in adult acute lymphoblastic leukaemia\u2014a population\u2010based analysis in 2007\u20132022"],"prefix":"10.1111","volume":"209","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1304-0784","authenticated-orcid":false,"given":"Erik","family":"Boberg","sequence":"first","affiliation":[{"name":"Division of Clinical Epidemiology, Department of Medicine Solna Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Haematology Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"L\u00fcbking","sequence":"additional","affiliation":[{"name":"Department of Haematology Oncology and Radiation Physics, Sk\u00e5ne University Hospital  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma Bergfelt","family":"Lennmyr","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Uppsala University  Uppsala Sweden"},{"name":"Department of Medicine Uppsala University Hospital  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline E.","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Division of Clinical Epidemiology, Department of Medicine Solna Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Joelsson","sequence":"additional","affiliation":[{"name":"Division of Clinical Epidemiology, Department of Medicine Solna Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Haematology Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin E.","family":"Smedby","sequence":"additional","affiliation":[{"name":"Division of Clinical Epidemiology, Department of Medicine Solna Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Haematology Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tove","family":"W\u00e4sterlid","sequence":"additional","affiliation":[{"name":"Division of Clinical Epidemiology, Department of Medicine Solna Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Haematology Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helene","family":"Hallb\u00f6\u00f6k","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Uppsala University  Uppsala Sweden"},{"name":"Department of Medicine Uppsala University Hospital  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70070-6"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01714-x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-05-018192"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10265"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.18537"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.01692"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2008.04.011"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2012.717080"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)30035-3"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.53.0808"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/RLI.0000000000000715"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-11-4666"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020010438"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2022.282332"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022017035"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-020-01029-9"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminoncol.2009.05.005"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2017.00004"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.3.547"},{"key":"e_1_2_10_21_1","unstructured":"Nationellt kvalitetsregister akut lymfatisk leukemi \u2010 RCC [Internet]. Available from:https:\/\/www.cancercentrum.se\/samverkan\/cancerdiagnoser\/blod\u2010lymfom\u2010myelom\/akut\u2010lymfatiskt\u2010leukemi\u2010all\/kvalitetsregister\/. Accessed April 17 2023."},{"key":"e_1_2_10_22_1","unstructured":"L\u00fcbkingA.RCC Syd. Validering av nationellt kvalitetsregister f\u00f6r ALL 2023.2024. Available from:https:\/\/cancercentrum.se\/globalassets\/cancerdiagnoser\/blod\u2010lymfom\u2010myelom\/all\/rapporter\/projektrapport\u2010\u20101\u2010validering\u2010av\u2010nationellt\u2010kvalitetsregister\u2010for\u2010all\u20102023.pdf. 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