What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children's Cancer Group and Cancer and Leukemia Group B studies

Abstract

We performed a retrospective comparison of presenting features, planned treatment, complete remission (CR) rate, and outcome of 321 adolescents and young adults (AYAs) ages 16 to 20 years with newly diagnosed acute lymphoblastic leukemia (ALL) who were treated on consecutive trials in either the Children's Cancer Group (CCG) or the Cancer and Leukemia Group B (CALGB) from 1988 to 2001. CR rates were identical, 90% for both CALGB and CCG AYAs. CCG AYAs had a 63% event-free survival (EFS) and 67% overall survival (OS) at 7 years in contrast to the CALGB AYAs, in which 7-year EFS was only 34% (P < .001; relative hazard rate [RHR] ‫؍‬ 2.2) and OS was 46% (P < .001; RHR ‫؍‬ 1.9). While CALGB AYAs aged 16 to 17 years achieved similar outcomes to all CCG AYAs with a 7-year EFS of 55%, the EFS for 18-to 20-year-old CALGB patients was only 29%. Comparison of the regimens showed that CCG AYAs received earlier and more intensive central nervous system prophylaxis and higher cumulative doses of nonmyelosuppressive agents. There were no differences in outcomes of those who reached maintenance therapy on time compared with those who were delayed. Based on these observations, a prospective study for AYAs with ALL using the more successful approach of the CCG has been initiated.

Phase 2 study of intensified chemotherapy and allogeneic hematopoietic stem cell transplantation for older patients with acute lymphoblastic leukemia

“…[3][4][5][6] However, the effect of therapeutic intensification in older adults has not been extensively studied, and this population is often excluded from clinical trials or transplantation studies. We now demonstrate that an intensified multi-agent approach can lead to promising results in older adults.…”

Leucemia linfoblástica aguda estirpe B Philadelphia negativa en adolescentes y adultos jóvenes: Resultados del Protocolo Terapéutico LLA 15-30, Programa Nacional de Cáncer del Adulto (PANDA), Ministerio de Salud, Chile

“…La mayor tasa de recaídas puede deberse a una menor adherencia de los pacientes con el equipo de hemato-oncólogos de adulto, así como a la postergación o reducción de dosis de quimioterapia en un intento por reducir la toxicidad, como se observa en diversas publicaciones internacionales [6][7][8][9][10][11] . …”

“…6 Hematóloga Panda Hospital san Juan de dios. 7 Hematólogo Panda Hospital sótero del río. 8 Hematólogo Panda Hospital Barros luco trudeau.…”

“…Este grupo de pacientes es clasificado de alto riesgo en grupos pediátricos, recibiendo esquemas de quimioterapia intensificados, con un mayor cumplimiento y adherencia. Más recientemente el uso de esquemas intensificados utilizados en pacientes adultos entre 15 y 45 años muestran una mejoría en la sobrevida global (SG), 62% a 5 años [6][7][8][9][10][11] . El Programa Nacional de Cáncer del Adulto (PANDA) ha incorporado diferentes protocolos para el tratamiento de la LLA, desde su inicio en 1988.…”

“…Estos resultados, inferiores en 10%-20% respecto a estudios internacionales en la década de los noventa, resultaban inaceptables considerando que la LLA en nuestro país afecta a adultos jóvenes, mediana de edad de 34 años. La sobrevida de este grupo etario en la literatura, llega a 50-60% con protocolos de adultos y 70-80% con protocolos pediátricos intensificados [6][7][8][9][10][11] .…”