Adolescents and young adults with acute lymphoblastic leukemia (ALL) had better outcomes with pediatric-inspired chemotherapy regimens than with conventional adult chemotherapy, a systematic review of studies has revealed.
Survival of adults with ALL is inferior to that of pediatric patients, noted a team headed by Dr. Ron Ram of Tel Aviv (Israel) University’s Sackler Faculty of Medicine and the Davidoff Cancer Center at the Rabin Medical Center in Petah-Tiqva, Israel, in American Journal of Hematology (2012;87:472-478). In a separate statement issued by American Friends of Tel Aviv University, Ram explained that in current practice, children up to age 15 years who have ALL typically undergo more aggressive chemotherapy than do adolescents and young adults (usually defined as persons aged 16 to 39 years); these older patients usually receive a round of chemotherapy followed by a bone marrow transplant.
According to background information in the statement, the general thinking among oncologists is that the organ systems of younger patients can better cope with aggressive treatment and are better able to repair themselves afterward. The older body, on the other hand, has less ability to heal itself, and adults may not be as psychologically well-adapted and supported as children to handle the hardships of intensive chemotherapy.
Ram and colleagues conducted a systematic review and meta-analysis of comparative trials of adolescent and young adult (AYA) patients with ALL who had been given induction chemotherapy with either pediatric-inspired regimens or conventional adult chemotherapy. Among 11 trials involving a total of 2,489 patients, AYA patients receiving pediatric-inspired regimens had an all-cause mortality rate at 3 years that was approximately 40% lower than that of AYA patients given conventional adult chemotherapy. Complete remission rate after induction chemotherapy and event-free survival were higher for the AYA patients engaged in pediatric-inspired regimens. Relapse rate was also lower for these patients, with comparable nonrelapse mortality between the two groups.
While acknowledging the lack of more randomized controlled trials, the researchers concluded nonetheless that pediatric-inspired regimens are superior to conventional adult chemotherapy for AYA patients with ALL, and they called for further randomized controlled studies to investigate this approach in adult ALL patients.