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Blood, 1 September 2008, Vol. 112, No. 5, pp. 1646-1654.
Prepublished online as a Blood First Edition Paper on May 23, 2008; DOI 10.1182/blood-2008-01-130237.
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Submitted January 9, 2008
Accepted April 27, 2008
What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of children's cancer group and cancer and leukemia group b studies
Wendy Stock*, Mei La, Ben Sanford, Clara D. Bloomfield, James W. Vardiman, Paul Gaynon, Richard A. Larson, and James Nachman
Section of Hematology/Oncology, Department of Medicine, University of Chicago and University of Chicago Cancer Research Center, Chicago, IL, United States
Statistical Center, Children's Oncology Group, Arcadia, CA, United States
Statistical Center, Cancer and Leukemia Group B, Durham, NC, United States
Department of Medicine, Arthur G. James Cancer Hospital and Research Institute, Columbus, Ohio, United States
Department of Pathology, University of Chicago, Chicago, IL, United States
Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA, United States
Dpeartment of Pediatrics, University of Chicago, Chicago, IL, United States
* Corresponding author; email: wstock{at}medicine.bsd.uchicago.edu.
We performed a retrospective comparison of presenting features, planned treatment, complete remission (CR) rate and outcome of 321 adolescents and young adults (AYAs) 16-20 years of age with newly diagnosed acute lymphoblastic leukemia (ALL) who were treated on consecutive trials in either the CCG or the CALGB during 1988-2001. CR rates were identical, 90% for both CALGB and CCG AYAs. CCG AYAs had a 63% event free survival (EFS) and 67% overall survival (OS) at 7 years in contrast to the CALGB AYAs where 7-year EFS was only 34% (p <0.0001; RHR = 2.2) and OS was 46% (p = 0.0002; RHR = 1.9). While CALGB AYAs 16-17 years old achieved similar outcomes to all CCG AYAs with a 7-year EFS of 55%, the EFS for 18-20 year old CALGB patients was only 29%. Comparison of the regimens showed that CCG AYAs received earlier and more intensive central nervous system prophylaxis and higher cumulative doses of non-myelosuppressive agents. There were no differences in outcomes of those who reached maintenance therapy on time compared to those who were delayed. Based on these observations, a prospective study for AYAs with ALL employing the more successful approach of the CCG has been initiated.
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