Improved prognosis for older adolescents with acute lymphoblastic leukemia

Ching Hon Pui, Deqing Pei, Dario Campana, W. Paul Bowman, John T. Sandlund, Sue C. Kaste, Raul C. Ribeiro, Jeffrey E. Rubnitz, Elaine Coustan-Smith, Sima Jeha, Cheng Cheng, Monika L. Metzger, Deepa Bhojwani, Hiroto Inaba, Susana C. Raimondi, Mihaela Onciu, Scott Howard, Wing Leung, James R. Downing, William E. Evans & 1 others Mary V. Relling

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Purpose: The prognosis for older adolescents and young adults with acute lymphoblastic leukemia (ALL) has been historically much worse than that for younger patients. We reviewed the outcome of older adolescents (age 15 to 18 years) treated in four consecutive Total Therapy studies to determine if recent improved treatment extended to this high-risk group. Patients and Methods: Between 1991 and 2007, 963 pediatric patients, including 89 older adolescents, were enrolled on Total Therapy studies XIIIA, XIIIB, XIV, and XV. In the first three studies, treatment selection was based on presenting clinical features and leukemic cell genetics. In study XV, the level of residual disease was used to guide treatment, which featured intensive methotrexate, glucocorticoid, vincristine, and asparaginase, as well as early triple intrathecal therapy for higher-risk ALL. Results: The 89 older adolescents were significantly more likely to have T-cell ALL, the t(4;11)(MLL-AF4), and detectable minimal residual disease during or at the end of remission induction; they were less likely to have the t(12;21)(ETV6-RUNX1) compared with younger patients. In the first three studies, the 44 older adolescents had significantly poorer event-free survival and overall survival than the 403 younger patients. This gap in prognosis was abolished in study XV: event-free survival rates at 5 years were 86.4% ± 5.2% (standard error) for the 45 older adolescents and 87.4% ± 1.7% for the 453 younger patients; overall survival rates were 87.9% ± 5.1% versus 94.1% ± 1.2%, respectively. Conclusion: Most older adolescents with ALL can be cured with risk-adjusted intensive chemotherapy without stem-cell transplantation.

Original languageEnglish (US)
Pages (from-to)386-391
Number of pages6
JournalJournal of Clinical Oncology
Volume29
Issue number4
DOIs
StatePublished - Feb 1 2011

Fingerprint

Precursor Cell Lymphoblastic Leukemia-Lymphoma
Disease-Free Survival
Therapeutics
Survival Rate
Precursor T-Cell Lymphoblastic Leukemia-Lymphoma
Remission Induction
Asparaginase
Residual Neoplasm
Stem Cell Transplantation
Vincristine
Methotrexate
Glucocorticoids
Young Adult
Pediatrics
Drug Therapy
Survival

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Pui, C. H., Pei, D., Campana, D., Bowman, W. P., Sandlund, J. T., Kaste, S. C., ... Relling, M. V. (2011). Improved prognosis for older adolescents with acute lymphoblastic leukemia. Journal of Clinical Oncology, 29(4), 386-391. https://doi.org/10.1200/JCO.2010.32.0325

Improved prognosis for older adolescents with acute lymphoblastic leukemia. / Pui, Ching Hon; Pei, Deqing; Campana, Dario; Bowman, W. Paul; Sandlund, John T.; Kaste, Sue C.; Ribeiro, Raul C.; Rubnitz, Jeffrey E.; Coustan-Smith, Elaine; Jeha, Sima; Cheng, Cheng; Metzger, Monika L.; Bhojwani, Deepa; Inaba, Hiroto; Raimondi, Susana C.; Onciu, Mihaela; Howard, Scott; Leung, Wing; Downing, James R.; Evans, William E.; Relling, Mary V.

In: Journal of Clinical Oncology, Vol. 29, No. 4, 01.02.2011, p. 386-391.

Research output: Contribution to journalArticle

Pui, CH, Pei, D, Campana, D, Bowman, WP, Sandlund, JT, Kaste, SC, Ribeiro, RC, Rubnitz, JE, Coustan-Smith, E, Jeha, S, Cheng, C, Metzger, ML, Bhojwani, D, Inaba, H, Raimondi, SC, Onciu, M, Howard, S, Leung, W, Downing, JR, Evans, WE & Relling, MV 2011, 'Improved prognosis for older adolescents with acute lymphoblastic leukemia', Journal of Clinical Oncology, vol. 29, no. 4, pp. 386-391. https://doi.org/10.1200/JCO.2010.32.0325
Pui CH, Pei D, Campana D, Bowman WP, Sandlund JT, Kaste SC et al. Improved prognosis for older adolescents with acute lymphoblastic leukemia. Journal of Clinical Oncology. 2011 Feb 1;29(4):386-391. https://doi.org/10.1200/JCO.2010.32.0325
Pui, Ching Hon ; Pei, Deqing ; Campana, Dario ; Bowman, W. Paul ; Sandlund, John T. ; Kaste, Sue C. ; Ribeiro, Raul C. ; Rubnitz, Jeffrey E. ; Coustan-Smith, Elaine ; Jeha, Sima ; Cheng, Cheng ; Metzger, Monika L. ; Bhojwani, Deepa ; Inaba, Hiroto ; Raimondi, Susana C. ; Onciu, Mihaela ; Howard, Scott ; Leung, Wing ; Downing, James R. ; Evans, William E. ; Relling, Mary V. / Improved prognosis for older adolescents with acute lymphoblastic leukemia. In: Journal of Clinical Oncology. 2011 ; Vol. 29, No. 4. pp. 386-391.
@article{ec1e6ddec92844688241ff06f22473e3,
title = "Improved prognosis for older adolescents with acute lymphoblastic leukemia",
abstract = "Purpose: The prognosis for older adolescents and young adults with acute lymphoblastic leukemia (ALL) has been historically much worse than that for younger patients. We reviewed the outcome of older adolescents (age 15 to 18 years) treated in four consecutive Total Therapy studies to determine if recent improved treatment extended to this high-risk group. Patients and Methods: Between 1991 and 2007, 963 pediatric patients, including 89 older adolescents, were enrolled on Total Therapy studies XIIIA, XIIIB, XIV, and XV. In the first three studies, treatment selection was based on presenting clinical features and leukemic cell genetics. In study XV, the level of residual disease was used to guide treatment, which featured intensive methotrexate, glucocorticoid, vincristine, and asparaginase, as well as early triple intrathecal therapy for higher-risk ALL. Results: The 89 older adolescents were significantly more likely to have T-cell ALL, the t(4;11)(MLL-AF4), and detectable minimal residual disease during or at the end of remission induction; they were less likely to have the t(12;21)(ETV6-RUNX1) compared with younger patients. In the first three studies, the 44 older adolescents had significantly poorer event-free survival and overall survival than the 403 younger patients. This gap in prognosis was abolished in study XV: event-free survival rates at 5 years were 86.4{\%} ± 5.2{\%} (standard error) for the 45 older adolescents and 87.4{\%} ± 1.7{\%} for the 453 younger patients; overall survival rates were 87.9{\%} ± 5.1{\%} versus 94.1{\%} ± 1.2{\%}, respectively. Conclusion: Most older adolescents with ALL can be cured with risk-adjusted intensive chemotherapy without stem-cell transplantation.",
author = "Pui, {Ching Hon} and Deqing Pei and Dario Campana and Bowman, {W. Paul} and Sandlund, {John T.} and Kaste, {Sue C.} and Ribeiro, {Raul C.} and Rubnitz, {Jeffrey E.} and Elaine Coustan-Smith and Sima Jeha and Cheng Cheng and Metzger, {Monika L.} and Deepa Bhojwani and Hiroto Inaba and Raimondi, {Susana C.} and Mihaela Onciu and Scott Howard and Wing Leung and Downing, {James R.} and Evans, {William E.} and Relling, {Mary V.}",
year = "2011",
month = "2",
day = "1",
doi = "10.1200/JCO.2010.32.0325",
language = "English (US)",
volume = "29",
pages = "386--391",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "4",

}

TY - JOUR

T1 - Improved prognosis for older adolescents with acute lymphoblastic leukemia

AU - Pui, Ching Hon

AU - Pei, Deqing

AU - Campana, Dario

AU - Bowman, W. Paul

AU - Sandlund, John T.

AU - Kaste, Sue C.

AU - Ribeiro, Raul C.

AU - Rubnitz, Jeffrey E.

AU - Coustan-Smith, Elaine

AU - Jeha, Sima

AU - Cheng, Cheng

AU - Metzger, Monika L.

AU - Bhojwani, Deepa

AU - Inaba, Hiroto

AU - Raimondi, Susana C.

AU - Onciu, Mihaela

AU - Howard, Scott

AU - Leung, Wing

AU - Downing, James R.

AU - Evans, William E.

AU - Relling, Mary V.

PY - 2011/2/1

Y1 - 2011/2/1

N2 - Purpose: The prognosis for older adolescents and young adults with acute lymphoblastic leukemia (ALL) has been historically much worse than that for younger patients. We reviewed the outcome of older adolescents (age 15 to 18 years) treated in four consecutive Total Therapy studies to determine if recent improved treatment extended to this high-risk group. Patients and Methods: Between 1991 and 2007, 963 pediatric patients, including 89 older adolescents, were enrolled on Total Therapy studies XIIIA, XIIIB, XIV, and XV. In the first three studies, treatment selection was based on presenting clinical features and leukemic cell genetics. In study XV, the level of residual disease was used to guide treatment, which featured intensive methotrexate, glucocorticoid, vincristine, and asparaginase, as well as early triple intrathecal therapy for higher-risk ALL. Results: The 89 older adolescents were significantly more likely to have T-cell ALL, the t(4;11)(MLL-AF4), and detectable minimal residual disease during or at the end of remission induction; they were less likely to have the t(12;21)(ETV6-RUNX1) compared with younger patients. In the first three studies, the 44 older adolescents had significantly poorer event-free survival and overall survival than the 403 younger patients. This gap in prognosis was abolished in study XV: event-free survival rates at 5 years were 86.4% ± 5.2% (standard error) for the 45 older adolescents and 87.4% ± 1.7% for the 453 younger patients; overall survival rates were 87.9% ± 5.1% versus 94.1% ± 1.2%, respectively. Conclusion: Most older adolescents with ALL can be cured with risk-adjusted intensive chemotherapy without stem-cell transplantation.

AB - Purpose: The prognosis for older adolescents and young adults with acute lymphoblastic leukemia (ALL) has been historically much worse than that for younger patients. We reviewed the outcome of older adolescents (age 15 to 18 years) treated in four consecutive Total Therapy studies to determine if recent improved treatment extended to this high-risk group. Patients and Methods: Between 1991 and 2007, 963 pediatric patients, including 89 older adolescents, were enrolled on Total Therapy studies XIIIA, XIIIB, XIV, and XV. In the first three studies, treatment selection was based on presenting clinical features and leukemic cell genetics. In study XV, the level of residual disease was used to guide treatment, which featured intensive methotrexate, glucocorticoid, vincristine, and asparaginase, as well as early triple intrathecal therapy for higher-risk ALL. Results: The 89 older adolescents were significantly more likely to have T-cell ALL, the t(4;11)(MLL-AF4), and detectable minimal residual disease during or at the end of remission induction; they were less likely to have the t(12;21)(ETV6-RUNX1) compared with younger patients. In the first three studies, the 44 older adolescents had significantly poorer event-free survival and overall survival than the 403 younger patients. This gap in prognosis was abolished in study XV: event-free survival rates at 5 years were 86.4% ± 5.2% (standard error) for the 45 older adolescents and 87.4% ± 1.7% for the 453 younger patients; overall survival rates were 87.9% ± 5.1% versus 94.1% ± 1.2%, respectively. Conclusion: Most older adolescents with ALL can be cured with risk-adjusted intensive chemotherapy without stem-cell transplantation.

UR - http://www.scopus.com/inward/record.url?scp=79952087452&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952087452&partnerID=8YFLogxK

U2 - 10.1200/JCO.2010.32.0325

DO - 10.1200/JCO.2010.32.0325

M3 - Article

VL - 29

SP - 386

EP - 391

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 4

ER -