Outcomes worse for older ALL patients

Teenagers and young adults with acute lymphoblastic leukemia (ALL) are more likely to relapse and less likely to survive than younger children with the disease, according to a report from the Children’s Oncology Group presented at the American Society of Clinical Oncology meeting in Chicago.

In a phase 3 study, patients aged 1 to 30 years with newly diagnosed, B-precursor high-risk ALL were randomized to receive dexamethasone or prednisone during the induction phase and high-dose methotrexate versus escalating Capizzi methotrexate during interim maintenance I. Of the 2,574 eligible patients, 501 were aged between 16 and 30 years.

The 5-year, event-free survival and the overall survival rates were significantly lower for teenagers and young adults (68% and 80%, respectively) compared with younger patients (81% and 88%, respectively). At 5 years, 21% of teenagers and young adults had relapsed compared with 13% of younger patients, largely because of a higher rate of bone marrow relapse. In addition, fewer teenagers and young adults achieved remission. Deaths after induction therapy and remission were also much higher among the older patients: 5.5% compared with 2% in the younger patients.

To improve the outcome of adolescents and young adults with high-risk ALL, effective strategies are needed to eradicate this more resistant disease and lower the toxicity of therapy for patients, the researchers concluded.

Go back to the current issue of the eConsult.