Abstract
In the last two decades great improvements have been made in the treatment of childhood acute lymphoblastic leukemia, with 5-year overall survival rates currently approaching almost 90%. In comparison, results reported in adolescents and young adults (AYAs) are relatively poor. In adults, results have improved, but are still lagging behind those obtained in children. Possible reasons for this different pattern of results include an increased incidence of unfavorable and a decreased incidence of favorable cytogenetic abnormalities in AYAs compared with children. Furthermore, in AYAs less intensive treatments (especially lower cumulative doses of drugs such as asparaginase, corticosteroids and methotrexate) and longer gaps between courses of chemotherapy are planned compared to those in children. However, although favorable results obtained in AYAs receiving pediatric protocols have been consistently reported in several international collaborative trials, physicians must also be aware of the specific toxicity pattern associated with increased success in AYAs, since an excess of toxicity may compromise overall treatment schedule intensity. Cooperative efforts between pediatric and adult hematologists in designing specific protocols for AYAs are warranted.
Highlights
Rationale for a pediatric-inspired approach in the adolescent and young adult population with acute lymphoblastic leukemia, with a focus on asparaginase treatment
Conference presentation: this paper summarizes the proceedings from a European acute lymphoblastic leukemia (ALL) Working Group (EWALL) meeting held in Bologna (Italy) on March 15, 2013
Surveillance Epidemiology and End Results e (SEER) 2000-2004 reported 10-year overall survival (OS) of s around 80% in children aged under 15 years, u falling to 60% in adolescents aged 15-20 years and 30% in young adults aged 20-30 years; l rates have improved by a further 10-15% over ia the past decade in the AYA group
Summary
Dell’Adulto (GIMEMA) protocol provides an the completion of the treatment schedule is native ASP, intensified first consolidation, six example of current treatment in AYAs in essential to ensure the expected full clinical doses of high dose methotrexate and ASP dur-. Patients receive year follow-up, EFS in children who received patients receiving the later protocol (GMALL induction Ia (vincristine, daunorubicin, ASP less than 25 weeks of planned ASP therapy was 07/03) had significant improvements in 5-year and prednisone) followed by induction Ib significantly poorer than in those who received OS compared with GMALL 05/93 (65% in (cyclophosphamide, 6-MP and cytarabine). High-risk received more than 50% of the scheduled dose A number of other studies have been carried patients receive consolidation therapy in three had a significantly improved 5-year EFS versus out using retrospective data to compare outsteps; step 1 (dexamethasone, vincristine, those who received less than 50% of the sched- comes in AYAs receiving pediatric and adult methotrexate, cytarabine and ASP), step 2 uled dose: 92.9% versus 74.1%, P
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