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ASH 2015: Young Adults With Acute Lymphoblastic Leukemia Have Encouraging Survival With Pediatric Chemotherapy Regimen

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Key Points

  • The current successor trial was carried out to determine if a native E coli asparaginase could be replaced by a safer and longer lasting compound, pegylated asparaginase.
  • Overall survival and disease-free survival at 3 years exceeded 70% in patients between 18 and 50 years old.
  • The survival gains came at a cost of toxicity resulting in two deaths, pancreatitis in four patients, allergic reactions, infections, and blood clots.

Using a pediatric chemotherapy regimen to treat young adults with acute lymphoblastic leukemia (ALL) significantly improved their outcomes compared to what has historically been achieved with “adult” treatment protocols, report Dana-Farber Cancer Institute scientists.

Overall survival and disease-free survival at 3 years exceeded 70% in patients between 18 and 50 years old, according to results of a multicenter phase II trial presented by DeAngelo et al at the 57th American Society of Hematology (ASH) Annual Meeting (Abstract 80).

“This is better than the 40% historically seen in this patient group,” said Richard Stone, MD, senior author of the study abstract, who added that the median survival rate had not yet been reached. Daniel DeAngelo, MD, PhD, of Dana-Farber, is the first author and leader of the study. This was a single-arm trial with no control group.

Pediatric Regimens in Older Patients

ALL is most common in early childhood and most can be successfully treated with chemotherapy. About 1,000 new cases are diagnosed annually in adults, who have a poorer prognosis; most of the deaths from ALL occur in older patients.

Dr. DeAngelo and others at Dana-Farber and elsewhere have observed that young adults treated by pediatric oncologists for ALL fared better than those who underwent standard adult regimens, which include more drugs that suppress bone marrow function. As a result, pediatric regimens have been tried in young adult patients, yielding improved outcomes, said Dr. Stone. “I've put many patients on this regimen, and they have been doing very well.”

Study Details

Earlier in 2015, Drs. DeAngelo and Stone reported in Leukemia that a pediatric drug combination that included a native E coli asparaginase compound achieved a 4-year disease-free and overall survival rate of 69%.

The current successor trial was carried out to determine if the same regimen but using a safer and longer lasting compound, pegylated asparaginase, could be feasibly administered to adults. In this trial, 110 high-risk young adult ALL patients received the pediatric regimen, given initially to induce a remission followed—in those who achieved remission—by 2 years of consolidation and continuation therapy. They also received additional chemotherapy and radiation designed to kill any leukemia cells in the brain and central nervous system.

The survival gains came at a cost of toxicity resulting in two deaths, pancreatitis in four patients, allergic reactions, infections, and blood clots. “The dose and schedule of pegylated asparaginase that is well-tolerated in adults is lower than can be used in pediatric patients,” the authors cautioned.

Nevertheless, they concluded that the regimen is “tolerable in young adults with ALL and represent a major therapeutic advance.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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