Pediatric-Inspired Treatment Regimens for Adolescents and Young Adults With Philadelphia Chromosome–Negative Acute Lymphoblastic Leukemia

Siegel, Stuart E.; Stock, Wendy; Johnson, Rebecca H.; Advani, Anjali S.; Muffly, Lori; Douer, Dan; Reed, Damon R.; Lewis, Mark A.; Freyer, David R.; Shah, Bijal; Luger, Selina M.; Hayes‐Lattin, Brandon; Jaboin, Jerry J.; Coccia, Peter F.; DeAngelo, Daniel J.; Seibel, Nita L.; Bleyer, Archie

doi:10.1001/jamaoncol.2017.5305

Cited by 117 publications

(109 citation statements)

References 68 publications

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“…The greatest effort during the last decade to increase accruals in AYAs was directed at ALL, the most common pediatric cancer. New clinical trials in ALL specifically designed for AYAs were launched, the National Comprehensive Cancer Network (NCTN) released practice guidelines for ALL, and an increasing number of presentations and publications on the topic occurred at national meetings and appeared in the peer‐reviewed medical literature. Figure B shows the annual NCI CTEP‐sponsored treatment trial accruals for ALL during 2000–2015.…”

Section: Resultssupporting

confidence: 77%

Role of clinical trials in survival progress of American adolescents and young adults with cancer—and lack thereof

Bleyer

Tai²,

Siegel

2018

Pediatric Blood & Cancer

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In the United States, adolescent and young adult (AYA) patients with cancer have the lowest clinical trial participation rate of all age groups and slower progress in survival improvement than younger patients. Ominously, AYA clinical trial participation has been steadily decreasing since 2010, except in 15–19 year olds and AYAs with acute lymphoblastic leukemia. In order to reverse the accrual trend, multiple changes are necessary, including convincing community oncologists to pursue clinical trials on behalf of their AYA patients and to have the new National Community Oncology Research Program and National Clinical Trials Network lead a coordinated effort to increase accrual.

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Section: Resultssupporting

confidence: 77%

Role of clinical trials in survival progress of American adolescents and young adults with cancer—and lack thereof

Bleyer

Tai²,

Siegel

2018

Pediatric Blood & Cancer

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“…Adolescent and YA patients with ALL represent a population with specific characteristics and needs . At present it is well established that adolescents aged 15 to 20 years are best treated with full pediatric protocols; in parallel, growing evidence suggests that this might also be true for YA (with an upper age limit of 30 to 40 years in most studies or even up to 50‐55 years in some studies), with 5‐year survival rates around 70%, despite HSCT is less used in pediatric trials.…”

Section: Discussionmentioning

confidence: 99%

A pediatric regimen for adolescents and young adults with Philadelphia chromosome‐negative acute lymphoblastic leukemia: Results of the ALLRE08 PETHEMA trial

et al. 2020

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Background Pediatric‐based or ‐inspired trials have improved the prognosis of adolescents and young adults (AYA) with Philadelphia chromosome‐negative (Ph‐neg) acute lymphoblastic leukemia (ALL). Methods This study reports the results of treatment of the ALLRE08 trial, a full pediatric trial for AYA aged 15‐30 years with standard‐risk (SR) ALL. Results From 2008 to 2018, 89 patients (38 adolescents [15‐18 years] and 51 young adults [YA, 19‐30 years], median age: 20 [15‐29] years) were enrolled in the ALLRE08 trial. The complete response (CR) was 95%. Twenty‐two patients were transferred to a high‐risk (HR) protocol because of poor marrow response on day 14 (n = 20) or high‐level of end‐induction minimal residual response (MRD ≥ 0.25%, n = 2). Cumulative incidence of relapse (CIR) at 5 years was 35% (95%CI: 23%‐47%), with significant differences between adolescents and YA: 13% (4%‐28%) vs 52% (34%‐67%), P = .012. No treatment‐related mortality was observed in 66/66 patients following the ALLRE08 trial vs 3/23 patients moved to a HR trial. The estimated 5‐year overall survival (OS) was 74% (95%CI: 63%‐85%), with significantly higher rates for adolescents vs YA: 87% (95%CI: 74%‐100%) vs 63% (46%‐80%), P = .021. Although CIR or OS were lower in patients who were transferred to a HR trial, the differences were not statistically significant (CIR: 34% [21%‐47%] vs 37% [14%‐61%]; OS: 78% [66%‐90%] vs 61% [31%;91%]). Conclusion A full pediatric trial is feasible and effective for AYA with Ph‐neg, SR‐ALL, with better results for adolescents than for YA. Outcome of patients with poor early response rescued with a HR trial was not significantly inferior.

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“…The intrinsic biology of AYA disease is unique from other groups and in need of further clinical trials, and basic biologic and translational research. This would allow for the development of novel therapeutic agents and regimens specific to AYA . There is much debate about how to effectively maximize AYA treatment.…”

Section: Introductionmentioning

confidence: 99%

Future health of AYA survivors

Burkart

Sanford

Dinner

et al. 2018

Pediatric Blood & Cancer

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Adolescent and young adult (AYA) oncology patients (ages 15–39) have been identified as a group with healthcare disparities including gaps and challenges in diagnosis, access to care, research, clinical trial participation, and cure rates. Like other patient groups with cancer or other chronic illnesses, disparities can lead to poor future health and outcomes, which is a well‐recognized concern within the AYA population. Cancer is the leading disease‐related cause of death in this age range. Numerous interested groups including the National Cancer Institute have met to address the research and cancer care needs of AYAs. This review highlights how these gaps in care during and after treatment can affect future health of this population of patients. Access to care, models of survivorship care, and lack of provider education are discussed. Survivorship care and use of guidelines, and promotion of psychosocial support and health behaviors during treatment and beyond are essential to optimizing future health of AYA patients.

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Pediatric-Inspired Treatment Regimens for Adolescents and Young Adults With Philadelphia Chromosome–Negative Acute Lymphoblastic Leukemia

Cited by 117 publications

References 68 publications

Role of clinical trials in survival progress of American adolescents and young adults with cancer—and lack thereof

Role of clinical trials in survival progress of American adolescents and young adults with cancer—and lack thereof

A pediatric regimen for adolescents and young adults with Philadelphia chromosome‐negative acute lymphoblastic leukemia: Results of the ALLRE08 PETHEMA trial

Future health of AYA survivors

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