Young age linked to better survival for lymphoblastic leukemia
MedWire News: Adolescent and young adult (AYA) patients with high-risk B-precursor acute lymphoblastic leukemia (HR-ALL) have lower rates of event-free survival (EFS) and overall survival (OS) compared with those aged 15 years or younger, findings claim.
The phase III study findings were presented at the American Society of Clinical Oncology Annual Meeting in Chicago, Illinois, USA.
Although previous research suggests that AYA patients with HR-ALL have inferior outcomes, to date there has not been a trial performed with substantial numbers of patients who have received the same treatment to make a direct comparison.
"This study tells us that the inferior outcome for AYA patients is the result of more resistant disease, resulting in higher rates of relapse and higher toxicity for treatment," said lead study author Eric Larsen (Children's Oncology Group, Gainesville, Florida, USA) in an associated press release.
He added: "We have to find novel agents to better eradicate the leukemia, but while we want to intensify therapy, we also have to reduce toxicity."
Larsen and team assessed EFS and OS among 2574 patients with HR-ALL, of which 501 (20%) were AYA patients aged 16-30 years. Patients in the study were randomly assigned to receive treatment with dexamethasone or prednisone during induction and high-dose methotrexate or escalating Capizzi methotrexate during maintenance.
Both EFS and OS were significantly lower for AYA patients (68.0% and 79.8%) compared with younger patients (80.9% and 88.4%). Furthermore, the 5-year cumulative incidence of relapse was significantly higher for AYA patients relative to younger patients (21.3 vs 13.4%), which was largely a result of the higher rate of marrow relapse (15.2 vs 9.0%) and not central nervous system relapse (5.2 vs 3.7%).
In addition, significantly fewer AYA patients achieved remission compared with younger patients, defined as less than 5% marrow blasts at the end of induction (97.2 vs 98.8%).
No significant difference was seen in induction mortality between AYA and younger patients (2.4 vs 1.8%), although postinduction remission deaths were significantly more common among AYA patients at 5 years (5.5 vs 2.1%).
In light of the study findings, the Children's Oncology Group is considering several options to enhance leukemia control while reducing treatment toxicity. It is hoped that future strategies will continue to improve outcomes for AYA patients with HR-ALL.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Ingrid Grasmo