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A pediatric regimen for older adolescents and young adults with acute lymphoblastic leukemia: results of CALGB 10403

Wendy Stock, Selina M. Luger, Anjali S. Advani, Jun Yin, Richard C. Harvey, Charles G. Mullighan, Cheryl L. Willman, Noreen Fulton, Kristina M. Laumann, Greg Malnassy, Elisabeth Paietta, Edy Parker, Susan Geyer, Krzysztof Mrózek, Clara D. Bloomfield, Ben Sanford, Guido Marcucci, Michaela Liedtke, David F. Claxton, Matthew C. Foster, Jeffrey A. Bogart, John C. Grecula, Frederick R. Appelbaum, Harry Erba, Mark R. Litzow, Martin S. Tallman, Richard M. Stone and Richard A. Larson

Key Points

  • Using an intensive pediatric regimen for AYAs with ALL is feasible.

  • High rates of EFS and OS were seen compared with historical controls.

Publisher's Note: There is a Blood Commentary on this article in this issue.

Abstract

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. This trial was registered at www.clinicaltrials.gov as #NCT00558519.

  • Submitted October 22, 2018.
  • Accepted January 4, 2019.
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