Abstract
BackgroundPediatric‐based or ‐inspired trials have improved the prognosis of adolescents and young adults (AYA) with Philadelphia chromosome‐negative (Ph‐neg) acute lymphoblastic leukemia (ALL).MethodsThis study reports the results of treatment of the ALLRE08 trial, a full pediatric trial for AYA aged 15‐30 years with standard‐risk (SR) ALL.ResultsFrom 2008 to 2018, 89 patients (38 adolescents [15‐18 years] and 51 young adults [YA, 19‐30 years], median age: 20 [15‐29] years) were enrolled in the ALLRE08 trial. The complete response (CR) was 95%. Twenty‐two patients were transferred to a high‐risk (HR) protocol because of poor marrow response on day 14 (n = 20) or high‐level of end‐induction minimal residual response (MRD ≥ 0.25%, n = 2). Cumulative incidence of relapse (CIR) at 5 years was 35% (95%CI: 23%‐47%), with significant differences between adolescents and YA: 13% (4%‐28%) vs 52% (34%‐67%), P = .012. No treatment‐related mortality was observed in 66/66 patients following the ALLRE08 trial vs 3/23 patients moved to a HR trial. The estimated 5‐year overall survival (OS) was 74% (95%CI: 63%‐85%), with significantly higher rates for adolescents vs YA: 87% (95%CI: 74%‐100%) vs 63% (46%‐80%), P = .021. Although CIR or OS were lower in patients who were transferred to a HR trial, the differences were not statistically significant (CIR: 34% [21%‐47%] vs 37% [14%‐61%]; OS: 78% [66%‐90%] vs 61% [31%;91%]).ConclusionA full pediatric trial is feasible and effective for AYA with Ph‐neg, SR‐ALL, with better results for adolescents than for YA. Outcome of patients with poor early response rescued with a HR trial was not significantly inferior.
Highlights
In recent years, the results of treatment of adolescents and young adults (AYA) diagnosed with acute lymphoblastic leukemia (ALL) have significantly improved with the use of pediatric-based or -inspired protocols.[1,2,3] This was first observed when retrospective studies demonstrated clear differences in outcomes for AYA depending on enrollment in pediatric vs adult cooperative group studies, despite most adult treatment regimens evolving from a pediatric background
This study shows that treatment with a full pediatric protocol is feasible and effective for AYA with Philadelphia chromosome-negative (Ph-neg), SR-ALL, with better results for adolescents than for YA
Adolescent and YA patients with ALL represent a population with specific characteristics and needs.[1,2,3]
Summary
The results of treatment of adolescents and young adults (AYA) diagnosed with ALL have significantly improved with the use of pediatric-based or -inspired protocols.[1,2,3] This was first observed when retrospective studies demonstrated clear differences in outcomes for AYA depending on enrollment in pediatric vs adult cooperative group studies, despite most adult treatment regimens evolving from a pediatric background. The study was approved by the Institutional Review Boards of all the participating centers
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