Acute Lymphoblastic Leukemia in Young Adults Treated with Intensive “Pediatric” Type Protocol
- 89 Downloads
Young adults with acute lymphoblastic leukemia do better when treated on “pediatric” protocols. Young adults (18–30 years) with Ph-negative ALL treated between 2000 and 2014 were retrospectively analyzed. Two-hundred and thirty-two patients were included [median age 21 years (18–30); 176 (76%) males; median WBC 16,000/cmm]. Protocols used were: BFM 95 (N = 147, 63%), MCP-841 (N = 51, 22%), GMALL (N = 21, 9%), INCTR (N = 9, 4%) and UKALL (N = 4, 2%). Complete remission was achieved in 194/232 (84%). Twenty patients (9%) died due to toxicity which was higher with BFM versus others (18/147 vs. 2/85; p = 0.031). After a median follow-up of 48 months, median RFS and OS were 35.5 months (25–46), and 25 months (18–31) and actuarial RFS and OS (5-years) were 45% (37–53) and 39% (32–46). BFM protocol improved RFS (51 vs. 35%, p = 0.027) but not OS (43 vs. 33%, p = 0.2). The survival outcomes reported are 15–20% lower than those reported from West. Better supportive care and risk-adapted therapy may improve outcomes.
KeywordsAcute lymphoblastic leukemia India BFM protocol Young adult
Ms. Vanitha Rajagopalan for helping with collection of data. We acknowledge financial support from Rashtriya Arogya Nidhi, Indian Cancer Society Fund, and the Kalyani Memorial Fund for provided support which partly offset the treatment costs of these patients.
The study was supported by Cancer Institute (WIA) funds. No Grant number is applicable.
Compliance with Ethical Standards
Conflict of interest
None of the authors have any relevant conflicts of interests to declare.
This study was a retrospective analysis of outcomes and doesn’t require ethical committee approval as per our Institute policy.
- 7.Mukhopadhyay D, Gupta P, Mukhopadhyay S, Chitalkar P, Banavali SD, Advani SH et al (2007) Result of childhood acute lymphoblastic leukemia protocol (INCTR) from a developing country[abstract]. J Clin Oncol 25(18S):20015Google Scholar
- 8.Möricke A, Reiter A, Zimmermann M, Gadner H, Stanulla M, Dördelmann M et al (2008) Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95. Blood 111(9):4477–4489CrossRefPubMedGoogle Scholar
- 10.Hough R, Rowntree C, Goulden N, Mitchell C, Moorman A, Wade R et al (2016) Efficacy and toxicity of a paediatric protocol in teenagers and young adults with Philadelphia chromosome negative acute lymphoblastic leukaemia: results from UKALL 2003. Br J Haematol 172(3):439–451CrossRefPubMedGoogle Scholar
- 11.Vora A, Goulden N, Wade R, Mitchell C, Hancock J, Hough R et al (2013) Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial. Lancet Oncol 14(3):199–209CrossRefPubMedGoogle Scholar
- 12.Ribera JM, Oriol A, Sanz MA, Tormo M, Fernández-Abellán P, del Potro E et al (2008) Comparison of the results of the treatment of adolescents and young adults with standard-risk acute lymphoblastic leukemia with the Programa Español de Tratamiento en Hematología pediatric-based protocol ALL-96. J Clin Oncol 26(11):1843–1849CrossRefPubMedGoogle Scholar
- 14.Rijneveld AW, van der Holt B, Daenen SM, Biemond BJ, de Weerdt O, Muus P et al (2011) Intensified chemotherapy inspired by a pediatric regimen combined with allogeneic transplantation in adult patients with acute lymphoblastic leukemia up to the age of 40. Leukemia 25(11):1697–1703CrossRefPubMedGoogle Scholar
- 16.Beck J, Brandt K, Bruggemann M, Burmeister T, Diedrich H, Faul C et al (2013) Significant improvement of outcome in adolescents and young adults (AYAs) aged 15–35 years with acute lymphoblastic leukemia (ALL) with a pediatric derived adult ALL protocol; results of 1529 AYAs in 2 consecutive trials of the German Multicenter Study Group for Adult ALL (GMALL). Blood 122(21):389Google Scholar
- 17.Hayakawa F, Sakura T, Yujiri T, Kondo E, Fujimaki K, Sasaki O et al (2014) Markedly improved outcomes and acceptable toxicity in adolescents and young adults with acute lymphoblastic leukemia following treatment with a pediatric protocol: a phase II study by the Japan Adult Leukemia Study Group. Blood Cancer J 4:e252CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Stock W, Luger SM, Advani AS, Geyer S, Harvey RC, Mullighan CC et al (2014) Favorable outcomes for older adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL): early results of U.S. Intergroup Trial C10403. Blood 124(21):796Google Scholar