Children and young adults with acute lymphocytic leukaemia (ALL) typically have better treatment outcomes than adults, due in part to differences in the disease, but also to higher-intensity paediatric treatment protocols.

While research indicates that more intensive paediatric regimens may be more effective, patients characterised as 'adolescent' or 'young adult' (patients aged 16-39) most often receive adult regimens.

To determine whether adolescent and young adult ALL patients would have better outcomes with paediatric regimens, 296 adolescent and young adult ALL patients participating in a large, prospective U.S. Intergroup clinical trial received the standard paediatric ALL treatment protocol, including four intensive courses of chemotherapy.

After two years of follow up, 78 percent of the patients had achieved overall survival and 66 percent of patients had maintained event-free survival (EFS). Factors linked to poor outcomes include high initial white blood cell counts as well as presence of minimal residual disease following completion of the first month of therapy. 

The nearly 30 percent of patients enrolled in the trial with a Ph-like gene expression signature indicating aggressive disease experienced markedly worse outcomes (52% two-year EFS vs. 81% EFS among those without the genetic alteration). Five patients died due to treatment-related reasons during therapy. 

“Our results illustrate a clear opportunity to improve care by treating adolescents and young adults with an intensive paediatric regimen, which resulted in low treatment-related mortality and achieved promising disease-free and overall survival,” said lead study author Wendy Stock, MD, of the University of Chicago Medical Centre.

“It is important to note that these results reflect a significant improvement from historical control studies, in which event-free survival was only 39 percent. With these new insights, we can now focus additional research on evaluating novel treatment combinations to reduce minimal residual disease in these patients to further improve their duration of response and long-term survival.”

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Source: ASH