TY - JOUR
T1 - A pediatric regimen for older adolescents and young adults with acute lymphoblastic leukemia
T2 - Results of CALGB 10403
AU - Stock, Wendy
AU - Luger, Selina M.
AU - Advani, Anjali S.
AU - Yin, Jun
AU - Harvey, Richard C.
AU - Mullighan, Charles G.
AU - Willman, Cheryl L.
AU - Fulton, Noreen
AU - Laumann, Kristina M.
AU - Malnassy, Greg
AU - Paietta, Elisabeth
AU - Parker, Edy
AU - Geyer, Susan
AU - Mrózek, Krzysztof
AU - Bloomfield, Clara D.
AU - Sanford, Ben
AU - Marcucci, Guido
AU - Liedtke, Michaela
AU - Claxton, David F.
AU - Foster, Matthew C.
AU - Bogart, Jeffrey A.
AU - Grecula, John C.
AU - Appelbaum, Frederick R.
AU - Erba, Harry
AU - Litzow, Mark R.
AU - Tallman, Martin S.
AU - Stone, Richard M.
AU - Larson, Richard A.
N1 - Publisher Copyright:
© 2019 by The American Society of Hematology.
PY - 2019/4/4
Y1 - 2019/4/4
N2 - Retrospective studies have suggested that older adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) have better survival rates when treated 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 those in the Children’s Oncology Group study AALL0232. From 2007 to 2012, 318 patients were enrolled; 295 were eligible and evaluable for response. Median age was 24 years (range, 17-39 years). Use of the pediatric regimen was safe; overall treatment-related mortality was 3%, and there were only 2 postremission deaths. Median event-free survival (EFS) was 78.1 months (95% confidence interval [CI], 41.8 to not reached), more than double the historical control of 30 months (95% CI, 22-38 months); 3-year EFS was 59% (95% CI, 54%-65%). Median overall survival (OS) was not reached. Estimated 3-year OS was 73% (95% CI, 68%-78%). Pretreatment risk factors associated with worse treatment outcomes included obesity and presence of the Philadelphia-like gene expression signature. Use of a pediatric regimen for AYAs with ALL up to age 40 years was feasible and effective, resulting in improved survival rates compared with historical controls. CALGB 10403 can be considered a new treatment standard upon which to build for improving survival for AYAs with ALL.
AB - Retrospective studies have suggested that older adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) have better survival rates when treated 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 those in the Children’s Oncology Group study AALL0232. From 2007 to 2012, 318 patients were enrolled; 295 were eligible and evaluable for response. Median age was 24 years (range, 17-39 years). Use of the pediatric regimen was safe; overall treatment-related mortality was 3%, and there were only 2 postremission deaths. Median event-free survival (EFS) was 78.1 months (95% confidence interval [CI], 41.8 to not reached), more than double the historical control of 30 months (95% CI, 22-38 months); 3-year EFS was 59% (95% CI, 54%-65%). Median overall survival (OS) was not reached. Estimated 3-year OS was 73% (95% CI, 68%-78%). Pretreatment risk factors associated with worse treatment outcomes included obesity and presence of the Philadelphia-like gene expression signature. Use of a pediatric regimen for AYAs with ALL up to age 40 years was feasible and effective, resulting in improved survival rates compared with historical controls. CALGB 10403 can be considered a new treatment standard upon which to build for improving survival for AYAs with ALL.
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U2 - 10.1182/blood-2018-10-881961
DO - 10.1182/blood-2018-10-881961
M3 - Article
C2 - 30658992
AN - SCOPUS:85063522947
SN - 0006-4971
VL - 133
SP - 1548
EP - 1559
JO - Blood
JF - Blood
IS - 14
ER -