4.7 Article

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

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BLOOD
卷 133, 期 14, 页码 1548-1559

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AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2018-10-881961

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  1. National Cancer Institute of the National Institutes of Health [U10CA180821, U10CA180882, P30CA033572, U10CA180790, U10CA180791, U10CA180820, U10CA180836, U10CA180838, U10CA180850, U10CA180867, U10CA180888, U10CA189859]
  2. Leadiant Biosciences, Inc.

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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.

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