In a nutshell
The review summarized results from recent studies that tested pediatric treatments for acute lymphoblastic leukemia (ALL) on adolescents and young adults (AYA). The main conclusion was that the pediatric treatment for AYA patients with ALL will result in better outcomes and survival.
Some background
Latest ALL treatments have dramatically improved survival in children. 40% of adolescents (15-18 years) and adult patients (aged up to 40 years) with ALL survive under traditional therapies. Survival rate reached 70% when they were treated with more intense pediatric techniques. It motivated several clinical trials to test pediatric ALL techniques on different age groups. It is necessary to summarize the evidence and data from all such studies.
Methods & findings
27 clinical trials tested pediatric ALL treatments on AYA patients with no Philadelphia (Ph)-chromosome. The presence of a Ph-chromosome is a cancerous genetic abnormality. 21 of them included AYAs aged up to 40 years and 6 included patients beyond 40. Pediatric techniques showed improved outcomes in 25 studies. A survey on AYA patients with ALL also showed that pediatric treatment caused longer survival compared to traditional techniques.
Patients' age influenced treatment outcomes while applying pediatric ALL treatment in AYAs. Complete remission (CR) is a period with no clinical signs of cancer. CR rates were 100% in patients younger than 25 years, 90% in patients up to 40 years and 85-90% in patients of 55 to 65 years of age. Overall, 60-70% of patients aged between 35-40 years survived for 5 years after therapy.
Other studies showed that overall survival (OS) was between 55%-60% for older patients (aged 60 or 65 years). Whereas, treatment benefits were reduced in patients over 45–55 years of age. This particular age group also had higher complications after receiving pediatric therapy in a French study.
Tyrosine kinase inhibitors (TKI) inactivate cancerous enzymes. TKIs led to better outcomes in patients with ALL and Ph-chromosome. These patients were generally older. They also had higher risks of leukemia’s return and treatment unresponsiveness.
The bottom line
The authors concluded that pediatric ALL treatment was effective in patients of all ages. They caused better outcomes and survival especially in AYAs, compared with traditional therapies.
Published By :
Therapeutic Advances in Hematology
Date :
Feb 20, 2020
