Abstract

Retrospective studies have suggested that older adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) had better survival rates when treatment was administered using a pediatric ALL regimen administered by pediatric treatment teams. To address the feasibility and efficacy of using a pediatric treatment regimen for AYA patients with newly diagnosed ALL administered by adult treatment teams, we performed a prospective study, CALGB 10403, with doses and schedule identical to Children's Oncology Group study AALL0232. From 2007-2012, 318 patients enrolled; 295 were eligible and evaluable for response. The median age was 24 years (range, 17-39). Use of the pediatric regimen was safe; overall treatment-related mortality was 3% and there were only two post-remission deaths. The median event-free survival (EFS) is 78.1 months (95% CI, 41.8-not reached), which is more than double the historical control of 30 months (95% CI, 22-38). The 3-year EFS is 59% (95% CI, 54-65%) The median overall survival (OS) has not been reached. The estimated 3-year overall survival is 73% (95% CI, 68-78%). Pretreatment risk factors associated with worse treatment outcomes included obesity and the presence of the Philadelphia-like gene expression signature. The use of a pediatric regimen for young adults with ALL up to age 40 years was feasible and effective, resulting in improved survival rates compared to historical controls. CALGB 10403 can be considered a new treatment standard upon which to build for improving survival for AYA ALL. ClinicalTrials.gov Identifier: NCT00558519.

View details for PubMedID 30658992