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An MRD-stratified pediatric protocol is as deliverable in adolescents and young adults as in children with ALL
Pediatric regimens have improved outcomes in adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL). However, results remain inferior to children with ALL. The Australasian Leukaemia and Lymphoma Group (ALLG) ALL06 study (anzctr.org.au/ACTRN12611000814976) was designed to assess whether...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Society of Hematology
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714725/ https://www.ncbi.nlm.nih.gov/pubmed/34662896 http://dx.doi.org/10.1182/bloodadvances.2021005576 |
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author | Greenwood, Matthew Trahair, Toby Sutton, Rosemary Osborn, Michael Kwan, John Mapp, Sally Howman, Rebecca Anazodo, Antoinette Wylie, Brenton D’Rozario, James Hertzberg, Mark Irving, Ian Yeung, David Coyle, Luke Jager, Amanda Engeler, Dan Venn, Nicola Frampton, Chris Wei, Andrew H. Bradstock, Kenneth Dalla-Pozza, Luciano |
author_facet | Greenwood, Matthew Trahair, Toby Sutton, Rosemary Osborn, Michael Kwan, John Mapp, Sally Howman, Rebecca Anazodo, Antoinette Wylie, Brenton D’Rozario, James Hertzberg, Mark Irving, Ian Yeung, David Coyle, Luke Jager, Amanda Engeler, Dan Venn, Nicola Frampton, Chris Wei, Andrew H. Bradstock, Kenneth Dalla-Pozza, Luciano |
author_sort | Greenwood, Matthew |
collection | PubMed |
description | Pediatric regimens have improved outcomes in adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL). However, results remain inferior to children with ALL. The Australasian Leukaemia and Lymphoma Group (ALLG) ALL06 study (anzctr.org.au/ACTRN12611000814976) was designed to assess whether a pediatric ALL regimen (Australian and New Zealand Children’s Haematology and Oncology Group [ANZCHOG] Study 8) could be administered to patients aged 15 to 39 years in a comparable time frame to children as assessed by the proportion of patients completing induction/consolidation and commencing the next phase of therapy (protocol M or high-risk [HR] treatment) by day 94. Minimal residual disease (MRD) response stratified patients to HR treatment and transplantation. From 2012 to 2018, a total of 86 patients were enrolled; 82 were eligible. Median age was 22 years (range, 16-38 years). Induction/consolidation was equally deliverable in ALL06 as in Study 8. In ALL06, 41.5% (95% confidence interval [CI], 30.7-52.9) commenced protocol M or HR therapy by day 94 vs 39.3% in Study 8 (P = .77). Median time to protocol M/HR treatment was 96 days (interquartile range, 87.5-103 days) in ALL06 vs 98 days in Study 8 (P = .80). Induction mortality was 3.6%. With a median follow-up of 44 months (1-96 months), estimated 3-year disease-free survival was 72.8% (95% CI, 62.8-82.7), and estimated 3-year overall survival was 74.9% (95% CI, 65.3-84.5). End induction/consolidation MRD negativity rate was 58.6%. Body mass index ≥30 kg/m(2) and day 79 MRD positivity were associated with poorer disease-free survival and overall survival. Pediatric therapy was safe and as deliverable in AYA patients as in children with ALL. Intolerance of pediatric ALL induction/consolidation is not a major contributor to inferior outcomes in AYA ALL. |
format | Online Article Text |
id | pubmed-8714725 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | American Society of Hematology |
record_format | MEDLINE/PubMed |
spelling | pubmed-87147252021-12-29 An MRD-stratified pediatric protocol is as deliverable in adolescents and young adults as in children with ALL Greenwood, Matthew Trahair, Toby Sutton, Rosemary Osborn, Michael Kwan, John Mapp, Sally Howman, Rebecca Anazodo, Antoinette Wylie, Brenton D’Rozario, James Hertzberg, Mark Irving, Ian Yeung, David Coyle, Luke Jager, Amanda Engeler, Dan Venn, Nicola Frampton, Chris Wei, Andrew H. Bradstock, Kenneth Dalla-Pozza, Luciano Blood Adv Clinical Trials and Observations Pediatric regimens have improved outcomes in adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL). However, results remain inferior to children with ALL. The Australasian Leukaemia and Lymphoma Group (ALLG) ALL06 study (anzctr.org.au/ACTRN12611000814976) was designed to assess whether a pediatric ALL regimen (Australian and New Zealand Children’s Haematology and Oncology Group [ANZCHOG] Study 8) could be administered to patients aged 15 to 39 years in a comparable time frame to children as assessed by the proportion of patients completing induction/consolidation and commencing the next phase of therapy (protocol M or high-risk [HR] treatment) by day 94. Minimal residual disease (MRD) response stratified patients to HR treatment and transplantation. From 2012 to 2018, a total of 86 patients were enrolled; 82 were eligible. Median age was 22 years (range, 16-38 years). Induction/consolidation was equally deliverable in ALL06 as in Study 8. In ALL06, 41.5% (95% confidence interval [CI], 30.7-52.9) commenced protocol M or HR therapy by day 94 vs 39.3% in Study 8 (P = .77). Median time to protocol M/HR treatment was 96 days (interquartile range, 87.5-103 days) in ALL06 vs 98 days in Study 8 (P = .80). Induction mortality was 3.6%. With a median follow-up of 44 months (1-96 months), estimated 3-year disease-free survival was 72.8% (95% CI, 62.8-82.7), and estimated 3-year overall survival was 74.9% (95% CI, 65.3-84.5). End induction/consolidation MRD negativity rate was 58.6%. Body mass index ≥30 kg/m(2) and day 79 MRD positivity were associated with poorer disease-free survival and overall survival. Pediatric therapy was safe and as deliverable in AYA patients as in children with ALL. Intolerance of pediatric ALL induction/consolidation is not a major contributor to inferior outcomes in AYA ALL. American Society of Hematology 2021-12-20 /pmc/articles/PMC8714725/ /pubmed/34662896 http://dx.doi.org/10.1182/bloodadvances.2021005576 Text en © 2021 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved. |
spellingShingle | Clinical Trials and Observations Greenwood, Matthew Trahair, Toby Sutton, Rosemary Osborn, Michael Kwan, John Mapp, Sally Howman, Rebecca Anazodo, Antoinette Wylie, Brenton D’Rozario, James Hertzberg, Mark Irving, Ian Yeung, David Coyle, Luke Jager, Amanda Engeler, Dan Venn, Nicola Frampton, Chris Wei, Andrew H. Bradstock, Kenneth Dalla-Pozza, Luciano An MRD-stratified pediatric protocol is as deliverable in adolescents and young adults as in children with ALL |
title | An MRD-stratified pediatric protocol is as deliverable in adolescents and young adults as in children with ALL |
title_full | An MRD-stratified pediatric protocol is as deliverable in adolescents and young adults as in children with ALL |
title_fullStr | An MRD-stratified pediatric protocol is as deliverable in adolescents and young adults as in children with ALL |
title_full_unstemmed | An MRD-stratified pediatric protocol is as deliverable in adolescents and young adults as in children with ALL |
title_short | An MRD-stratified pediatric protocol is as deliverable in adolescents and young adults as in children with ALL |
title_sort | mrd-stratified pediatric protocol is as deliverable in adolescents and young adults as in children with all |
topic | Clinical Trials and Observations |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714725/ https://www.ncbi.nlm.nih.gov/pubmed/34662896 http://dx.doi.org/10.1182/bloodadvances.2021005576 |
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