Older adolescents and young adults with acute lymphoblastic leukemia (ALL) in the United States: From the lowest to highest death rate and number of deaths—More rationale for the CALBG-SWOG-ECOG C10403 trial based on COG AALL0232

Abstract

18034 Background: In the U.S., children with ALL have had a dramatic mortality rate reduction whereas older patients have not (Proc. ASCO 21: 389a, 2002), a difference that has been known since 2000 to be largely attributable to differences in pediatric versus adult treatment regimens (Blood 2000;96:467a,abstr; J Clin Oncol 2003;21:774–80; Leukemia 2004;18:2032–5; Pediat Blood Cancer 2005;45:578,Abstr; J Clin Oncol 2006;24(18S):#9024,abstr; Pediatr Blood Cancer 2006,43:748–56). To ascertain whether there has been any improvement in the U.S. since these reports, national mortality rates were assessed as a function of year of age and year of diagnosis. Methods: National ALL deaths and death rates during 1969–2004 were obtained from the U.S. SEER program (SEERStat, www.seer.cancer.gov accessed 1/8/08). Best fit regressions (linear, polynomial or exponential) were used to determine trends and estimate rates for specific calendar years. Results: Below age 15 the national ALL mortality rate has declined dramatically, from 14.6 to 3.7 deaths per year per million from 1970 to 2004 and from 800+ deaths in 1970 to an average of 220 deaths per year during 2000–2004. In 1970, 15–24 year-olds had one-third the ALL death rate and one-third the number of deaths that occurred in younger patients. Since 1995, 15–19 and 20–24 year-olds have had a greater death rate than younger patients and the highest of all 5-year age groups younger than 55 years. The number of deaths from ALL has become higher in 15–24 year-olds than in any other 10-year age group (Table). Conclusions: The age dependent trend in death rates and number of deaths from ALL is more rationale for the CALBG-SWOG-ECOG C10403 trial, which opens this year in all three cooperative groups and will be preformed in conjunction with COG AALL0232. The upper age limit of this phase II trial is 30 years and should be accessible via the Cancer Trials Support Unit (CTSU). Age (Years) at [upper row] and Number of Deaths from ALL [lower row], U.S. 2000–2004 0–9 5–14 15–24 25- 34 35–44 45–54 55–64 65–74 75–84 85+ 687 834 959 615 677 781 818 885 818 773 No significant financial relationships to disclose.