This is a group of patients who have not done very well over the years. The cure rate for children with acute lymphoblastic leukemia (ALL) is over 90%, whereas this group of patients (ie, aged 18–50) typically has a 5-year survival of 40% to 50%. Use of pediatric regimens has boosted that survival, and in this trial, we have excellent survival of more than 70%, which is much higher than expected,” said Karen Ballen, MD, Director of the Leukemia Program at Massachusetts General Hospital, Boston, and coauthor of this study.

The Dana-Farber Cancer Institute pediatric regimen has three distinguishing features: prophylactic central nervous system therapy starting on day 1; high doses of asparaginase; and non–cross-resistant drugs with different side-effect profiles, which allow use of a number of drugs, she explained.

Take-Home Message

“The take-home message of this study is that younger adults should be treated with a pediatric regimen,” she stated. “The results in this study are among the best of the phase II trials that have been conducted.”

“You can now cure more ALL with a pediatric regimen. Younger patients can tolerate aggressive therapy and be treated with the intent to cure,” she added.

Dr. Ballen said a randomized, controlled trial is not likely in this rare disease. The Dana-Farber Cancer Institute ALL Consortium plans to evaluate modified versions of the pediatric regimen in patients over the age of 50. ■

Disclosure: Dr. Ballen reported no potential conflicts of interest.