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Olivier-Gougenheim L, Arfeuille C, Suciu S, Sirvent N, Plat G, Ferster A, de Moerloose B, Domenech C, Uyttebroeck A, Rohrlich PS, Cavé H, Bertrand Y. Pediatric randomized trial EORTC CLG 58951: Outcome for adolescent population with acute lymphoblastic leukemia. Hematol Oncol 2020; 38:763-772. [PMID: 32809224 DOI: 10.1002/hon.2791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/08/2022]
Abstract
Over the years, the prognosis of adolescents treated for acute lymphoblastic leukemia (ALL) has improved. However, this age group still represents a challenge with an overall survival (OS) of 60% compared to 85% in younger children. Herein, we report the outcome of adolescents treated in the European Organisation for Research and Treatment of Cancer (EORTC) 58951 clinical trial. EORTC 58951 clinical trial included patients with de novo ALL between 1998 and 2008. For this study, we analyzed data of all adolescents between 15 and under 18. Data from 97 adolescents were analyzed, 70 had B-lineage and 27 had T-lineage ALL. The 8-year event-free survival (EFS) and OS for the B-cell precursor ALL cases were 72.3% (59.4%-81.7%) and 80.8% (67.4%-89.1%), respectively. For the T-lineage, the 8-year EFS and OS were 57.4% (36.1%-74.0%) and 59.0% (36.1%-76.2%), respectively. "B-other" ALL, defined as BCP-ALL lacking any known recurrent genetic abnormalities were more frequent in our adolescent population (52.8%) than in younger children (27.1%). Outcome of adolescents in the EORTC 58951 study is supporting the findings that adolescents have better outcome in pediatric compared to adults' trials. Nevertheless, in pediatric studies, adolescents still have a worse prognosis than younger children. Despite the fact that specific unfavorable characteristics may be linked to the adolescent population, a careful study and characterization of adolescents "B-other" genetic abnormalities in ALL is critical to improve the outcome of this population.
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Affiliation(s)
- Laura Olivier-Gougenheim
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France
| | - Chloe Arfeuille
- Department of Genetic Biochemistry, Robert-Debré Hospital, AP-HP and University of Paris-Diderot, Paris, France
| | - Stefan Suciu
- European Organization for Research and Treatment of Cancer (EORTC), EORTC Headquarters, Brussels, Belgium
| | - Nicolas Sirvent
- Department of Pediatric and Adolescent Hematology-Oncology, Arnaud de Villeneuve Children's Hospital, Montpellier, France
| | - Geneviève Plat
- Department of Pediatric Hematology and Oncology, Toulouse University Hospital, Toulouse, France
| | - Alina Ferster
- Department of Hematology-Oncology, Reine Fabiola Children Hospital, Brussels, Belgium
| | | | - Carine Domenech
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France
| | - Anne Uyttebroeck
- Department of Pediatric Hematology-Oncology, University Hospitals Leuven, Leuven, Belgium
| | | | - Helene Cavé
- Department of Genetic Biochemistry, Robert-Debré Hospital, AP-HP and University of Paris-Diderot, Paris, France
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France
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Muffly L, Lichtensztajn D, Shiraz P, Abrahão R, McNeer J, Stock W, Keegan T, Gomez SL. Adoption of pediatric-inspired acute lymphoblastic leukemia regimens by adult oncologists treating adolescents and young adults: A population-based study. Cancer 2017; 123:122-130. [PMID: 27622953 PMCID: PMC5161602 DOI: 10.1002/cncr.30322] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Studies have demonstrated superior outcomes for adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) who are treated using pediatric versus adult therapeutic regimens. To the best of our knowledge, whether adult oncologists in the United States have adopted this approach to ALL in AYA patients is currently unknown. The objective of the current study was to provide a population-based description of ALL treatment patterns in AYA individuals over the past decade. METHODS Data regarding AYA patients aged 15 to 39 years and diagnosed with ALL between 2004 and 2014 while living in the Greater Bay Area were obtained from the Greater Bay Area Cancer Registry (GBACR). Treating facilities were designated as pediatric or adult centers; induction treatment regimens were abstracted from registry text data fields. RESULTS Of 304 patients diagnosed in the GBACR catchment region, complete treatment data were available for 229 (75%). The location of care was identified for 296 patients (97%) treated at 31 unique centers. Approximately 70% of AYA patients received induction therapy at an adult treatment center. All AYA patients who were treated at pediatric centers received pediatric ALL regimens. Among AYA patients treated by adult oncologists with complete treatment data, none received a pediatric regimen before 2008. Between 2008 and 2012, while the US Adult Intergroup C10403 pediatric-inspired ALL protocol was open to accrual, 31% of AYA patients treated by adult oncologists received pediatric regimens. This rate fell to 21% from 2013 through 2014. Adult facilities treating ≥ 2 AYA patients with ALL per year captured in the GBACR were more likely to administer pediatric regimens than lower volume centers (P = .03). CONCLUSIONS As of 2014, only a minority of AYA patients with ALL received pediatric ALL regimens at adult cancer centers. Cancer 2017;122-130. © 2016 American Cancer Society.
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Affiliation(s)
- Lori Muffly
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University, Stanford, California
- Stanford Cancer Institute, Stanford University, Stanford, California
| | | | - Parveen Shiraz
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University, Stanford, California
| | - Renata Abrahão
- Cancer Prevention Institute of California, Freemont, California
| | - Jennifer McNeer
- Section of Hematology/Oncology, Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Theresa Keegan
- Division of Hematology and Oncology, Department of Medicine, University of California at Davis School of Medicine, Sacramento, California
| | - Scarlett Lin Gomez
- Stanford Cancer Institute, Stanford University, Stanford, California
- Cancer Prevention Institute of California, Freemont, California
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Muffly LS, Hlubocky FJ, Khan N, Wroblewski K, Breitenbach K, Gomez J, McNeer JL, Stock W, Daugherty CK. Psychological morbidities in adolescent and young adult blood cancer patients during curative-intent therapy and early survivorship. Cancer 2016; 122:954-61. [DOI: 10.1002/cncr.29868] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/30/2015] [Accepted: 12/10/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Lori S. Muffly
- Division of Blood and Marrow Transplantation, Department of Medicine; Stanford University; Stanford California
| | - Fay J. Hlubocky
- Section of Hematology/Oncology, Department of Medicine; University of Chicago; Chicago Illinois
| | - Niloufer Khan
- Section of Hematology/Oncology, Department of Pediatrics; University of Chicago; Chicago Illinois
| | - Kristen Wroblewski
- Department of Public Health Sciences; University of Chicago; Chicago Illinois
| | - Katherine Breitenbach
- Section of Hematology/Oncology, Department of Medicine; University of Chicago; Chicago Illinois
| | - Joseline Gomez
- Section of Hematology/Oncology, Department of Medicine; University of Chicago; Chicago Illinois
| | - Jennifer L. McNeer
- Section of Hematology/Oncology, Department of Pediatrics; University of Chicago; Chicago Illinois
| | - Wendy Stock
- Section of Hematology/Oncology, Department of Medicine; University of Chicago; Chicago Illinois
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Shaw PH, Reed DR, Yeager N, Zebrack B, Castellino SM, Bleyer A. Adolescent and Young Adult (AYA) Oncology in the United States: A Specialty in Its Late Adolescence. J Pediatr Hematol Oncol 2015; 37:161-9. [PMID: 25757020 DOI: 10.1097/mph.0000000000000318] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the last 30 years, it has become apparent that oncology patients ages 15 to 39 have not reaped the same rewards of improved survival that we have seen in younger and older patients. As a result, in 2006 the Adolescent and Young Adult (AYA) Oncology Progress Review Group convened and examined the factors that impact the care of the 70,000 new cases per year (approximately 7% of all new cases) in the United States and published their findings. The reasons for inferior survival gains are of course multiple and include the settings in which patients are cared for, clinical trial enrollment, insurance coverage, varied treatment of sarcomas, varied treatment of acute lymphoblastic leukemia, the psychosocial impact of cancer and cancer survivorship. A new area of a yet-to-be completely defined subspecialty was born out of this meeting: AYA oncology. As a medical community we realized that these patients do not fit neatly into the pediatric nor adult world and, therefore, require a unique approach which many individuals, oncology centers, advocacy groups, and cooperative trial groups have started to address. This group of dedicated providers and advocates has made strides but there is still much work to be done on the local, national, and international level to make up for shortcomings in the medical system and improve outcomes. We review key components of AYA cancer care in 2015 that all providers should be aware of, how far we have come, where this movement is headed, and the obstacles that continue to stand in the way of better cure rates and quality of life after cure for this unique group of patients. Like an adolescent maturing into adulthood, this movement has learned from the past and is focused on moving into the future to achieve its goals.
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Affiliation(s)
- Peter H Shaw
- *Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA †Sarcoma Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL ‡Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH §University of Michigan School of Social Work, Ann Arbor, MI ∥Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC ¶Quality Department, St Charles Health System, Bend, OR
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