Children's oncology in St. Petersburg: achievements and prospects of development

2015 ◽  
Vol 6 (4) ◽  
pp. 5-12
Author(s):  
Margarita Borisovna Belogurova ◽  
Elmira Gosmanovna Boichenko ◽  
Svetlana Aleksandrovna Kulyova
Keyword(s):  
Overall Survival ◽  
Hodgkin’S Lymphoma ◽  
Malignant Tumors ◽  
Survival Rates ◽  
Hodgkin's Lymphoma ◽  
Genetic Diagnostics ◽  
Hereditary Cancer Syndrome ◽  
Event Free Survival ◽  
Cancer Syndrome ◽  
Free Survival

The statistics (incidence, mortality, survival) characterizing a problem and the oncological care to children with malignant tumors in St. Petersburg are presented in the article. It is proved that intensification in the therapeutic regimens according to immunohistochemical features, age, extending of tumor significantly raised survival rates, having approached them to the world. The five-year survival of children treated in the 90th of the last century in St. Petersburg, was 60,9 %, at the beginning of the 2000th increase of survival to 69,3 % with approach to European survival (71,8 %) is noted. Improvement of indicators of survival, first of all, should be explained with progress in therapy of the most widespread localizations - leukemias and central nervous system tumors. Thanks to an intensification of treatment it was succeeded to improve considerably results of treatment of children with acute leukemia: the survival from 10-15 % in the 70-80th reached 80 %. Traditionally good results were observed at Hodgkin’s lymphoma: the 5-year overall survival was 94% with event-free survival of 87 %. Using of the European protocol for treatment of Wilm’s tumor (SIOP 93-01) increased survival of children with a unilateral tumor to 94,4 % at the overall survival more than 80 %. Improvement of overall survival in children was influenced also by introduction in practice protocols of BFM (Berlin-Frankfurt-Münster) for treatment non-Hodgkin’s lymphoma thanks to what 5-year event-free survival increased from 30 to 81 %. Now the perspective in children’s oncology are development of molecular and genetic diagnostics with search the germ mutations at a hereditary cancer syndrome, definition of a range of somatic mutations in genes at sporadic malignant tumors at children.

Prerequisites to improvement of predictive model of childhood Hodgkin’s lymphoma

2015 ◽  
Vol 6 (4) ◽  
pp. 13-18
Author(s):  
Svetlana Aleksandrovna Kulyova ◽  
Andrei Petrovich Karitsky ◽  
Svetlana Viacheslavovna Ivanova
Keyword(s):  
Overall Survival ◽  
Hodgkin’S Lymphoma ◽  
Roc Analysis ◽  
Risk Group ◽  
Survival Rates ◽  
Late Results ◽  
Tumor Burden ◽  
Hodgkin's Lymphoma ◽  
Event Free Survival ◽  
Free Survival

Background. Calculation of relative tumor burden in Hodgkin’s lymphoma patients is the simplest and significant parameter which can be used in daily clinical practice as a risk factor. The aim of study was the assessment of influence of relative tumor burden on the late results of a disease. Material and methods. This research included data on 126 patients with Hodgkin’s lymphoma aged from 0 till 18 years (middle age of 11 years), treated risk-adapted treatment according to the DAL-HD and SPBLH-05. Boys was 70, girls - 56 (a ratio 1,25 : 1). Fifty-eight patients (46 %) are stratified in favorable risk group, 50 (39,7 %) - in intermediate risk group, and 50 (39,7 %) are included in unfavorable risk group. Results. Overall survival at 5 years was 93 % (range 91-95 %), event-free survival - 88 % (85-91 %). The average relative tumor burden was 129,4 cm3/m2 (7-609,7 cm3/m2). When carrying out ROC-analysis value of 122,7 cm3/m2 (р ˂ 0,0001) appeared the critical parameter, which worsen the prognosis of a disease. Overall survival in a patients cohort with this volume was 69,6 %, with the volume less than 122,7 cm3/m2 overall survival was 97,2 % (р = 0,00002). Conclusions. The relative tumor burden is the parameter which is significantly reducing survival rates in children with Hodgkin’s lymphoma. Opinion on interrelation of clinical and laboratory parameters with “sarkoma’s saturation” or tumor volume as end result of immunological frustration, it is represented the most perspective direction of studying of Hodgkin’s lymphoma.

An Improved Prognostic Parameter for Non-Hodgkin's Lymphoma Based on the Combination of Three Serum Tumor Markers

2008 ◽  
Vol 23 (4) ◽  
pp. 207-213
Author(s):  
W. Gui ◽  
T. Wang ◽  
J. Wang ◽  
L. Wang ◽  
J. He ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tumor Markers ◽  
Prognostic Value ◽  
Hodgkin’S Lymphoma ◽  
Survival Rates ◽  
Hodgkin's Lymphoma ◽  
Event Free Survival ◽  
Free Survival ◽  
Serum Tumor Markers ◽  
Non Hodgkin's Lymphoma

We aimed to evaluate the prognostic value of the combination of three serum tumor markers (LDH, β2-M and CA 125) in patients with non-Hodgkin's lymphoma (NHL). Clinical and pathological variables including the levels of these markers were measured in 415 NHL patients. Statistical analysis showed that increased levels of all three markers were associated with stage, B symptoms, effusions, bone marrow involvement, and International Prognostic Index (IPI) in NHL patients (p<0.05). Overall survival and event-free survival rates were associated not only with LDH but also with β2-M and CA125 (p<0.001). Response to treatment and overall survival rates were different in three groups with elevated LDH; in particular, the combination of three or two elevated markers seemed to identify a group of patients at higher risk of treatment failure and/or relapse than the group with a high LDH level only. Furthermore, multiple Cox regression analysis showed that IPI score complemented by the additional serum markers β2-M and CA125 was a better prognosticator of overall and event-free survival than LDH alone. This result suggests that if the combination of three elevated serum tumor markers is included as a parameter in the IPI instead of LDH alone, the prognostic value of IPI can be improved.

Outcomes of Eam Conditioned Autologous Haematopoietic Stem Cell Transplantation for Lymphoma. A Matched Pairs Retrospective Single Centre Study Analysis.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3088-3088
Author(s):  
Justin Ching Ting Loke ◽  
Janice Ward ◽  
Prem Mahendra ◽  
Sridhar Chaganti ◽  
Ram Malladi
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Lung Function ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Haematopoietic Stem Cell ◽  
Event Free Survival ◽  
Free Survival ◽  
Related Mortality

Abstract Abstract 3088 Background: High dose chemotherapy followed by autologous stem cell rescue is superior to salvage chemotherapy alone in relapsed Hodgkin's Lymphoma (HL) and Non-Hodgkin's lymphoma (NHL). A commonly used regimen is BEAM (BCNU, Etoposide, Cytarabine and Melphalan). Unfortunately, BCNU is associated with potentially lethal pulmonary interstitial toxicity, in a dose dependent manner. Therefore, it is often omitted in conditioning regimens for patients who have pre-existing impaired lung function. We aimed to determine the outcomes of patients given this EAM (Etoposide, Cytarabine, Melphalan) schedule in our centre. Method: At our unit, from 2000–2010, 338 patients had been transplanted with BEAM conditioning and 23 patients with an EAM regimen. BEAM chemotherapy involved cumulative doses of BCNU at 300 mg/m2, etoposide at 800 mg/m2, cytarabine at 1600 mg/m2 and melphalan at 140 mg/m2. The EAM regimen was the same, except for the omission of BCNU. We wanted to compare overall survival, event free survival and transplant related mortality between the two groups of patients. A matched-pair analysis based on age and sex on a 1:1 basis was conducted. Survival rates were estimated by the Kaplan-Meier method. Differences between the survival distributions were compared with the log-rank test. Results: 23 patients transplanted with an EAM regimen was matched with an equal number transplanted with a BEAM conditioning regimen. The median age was 53 in both groups. The median follow-up for patients alive was 3.2 years. Further baseline characteristics of the two groups are described in table 1. Other than a slight predominance of more advanced disease in the BEAM cohort, the two groups were evenly matched. Survival estimates were statistically significantly poorer for the EAM group compared to the BEAM group. The median overall survival for the EAM cohort was 29 months compared to 77 months (p=0.03) for the matched BEAM cohort. The median event free survival for the EAM cohort was 11 months compared to 63 months (p=0.02) for the BEAM cohort. The 100 day transplant related mortality was 8.7% for both cohorts. During the follow-up period 11 patients died of disease related causes in the EAM group compared to 6 in the BEAM group. Conclusion: Despite the prevalence of pre-existing lung disease in the EAM group of patients, the conditioning was reasonably well tolerated. Our analysis suggests that patient transplanted with an EAM regimen had an inferior survival outcome to patients treated with the standard BEAM regimen. This data provides evidence for the importance of BCNU in lymphoma control; consideration should be given to a reduction in BCNU dosage, rather than simple omission, for patients with borderline lung function results. Collaboration with other centres is warranted to determine if this experience with EAM is replicated elsewhere. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Treatment results of Hodgkin’s lymphoma

Medicina ◽  
2009 ◽  
Vol 45 (8) ◽  
pp. 615 ◽  
Author(s):  
Eduardas Aleknavičius ◽  
Konstantinas Valuckas ◽  
Birutė Aleknavičienė ◽  
Laura Norkienė ◽  
Giedrė Smailytė
Keyword(s):  
Overall Survival ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Intermediate Stage ◽  
Hodgkin's Lymphoma ◽  
Advanced Stage ◽  
Event Free Survival ◽  
Early Stage Disease ◽  
Free Survival ◽  
Stage Disease

During last decades, there are strengthening attitudes to optimize the treatment of Hodgkin’s lymphoma considering prognostic groups and risk factors. Based on the data of Vilnius University Clinics, a retrospective study was carried out, and treatment methods and outcomes of the patients treated during 1999– 2004 were analyzed. Medical histories of 114 patients younger than 60 years were reviewed. Median age was 28 years. In 83% of cases, classic nodular sclerotic Hodgkin’s lymphoma was diagnosed. Advanced-, intermediate-, and early-stage disease was diagnosed in 55%, 38%, and 7% of cases, respectively. The patients with early-stage disease underwent four ABVD chemotherapy courses; 88% of them underwent radiotherapy afterwards. The patients with intermediate-stage disease underwent 4–6 courses of ABVD or in minor cases (12% of patients with intermediate-stage disease) – 4 standard BEACOPP chemotherapy courses. After this treatment, 88% of patients with intermediate-stage disease underwent radiotherapy. Patients with advanced-stage disease underwent 8 escalate (44%) or standard BEACOPP (29%) chemotherapy courses. More than half of these patients (71%) underwent radiotherapy after chemotherapy. Patient follow-up median was 65 months. One hundred seven patients (94%) after primary treatment achieved complete remission, in 7 patients (6%) primary progression was observed, 12 patients (11%) relapsed, and 8 patients died. Overall survival and event-free survival in patients with early-stage disease was 100%. Overall survival in patients with early/intermediate- and advanced-stage disease was 95.1% and 84.0%, respectively. Event-free survival in patients with early/intermediate- and advanced-stage disease was 91.7% and 76.2%, respectively. In the groups of intermediate- and advanced-stage disease, the results of treatment were worse in the subgroup, which underwent extended-field radiotherapy (P<0.05). Overall survival in the group of patients with advanced-stage disease was the best who underwent ABVD scheme, but the event-free survival (70.6%) and disease-free survival (81.3%) in ABVD subgroup were worse compared to BEACOPP subgroup. According to our results, there was no statistically significant difference in survival of patients with advanced-stage disease who underwent or did not radiotherapy (P>0.05).

Effect of Race on the Outcome of Pediatric Patients With Hodgkin's Lymphoma

2008 ◽  
Vol 26 (8) ◽  
pp. 1282-1288 ◽  
Author(s):  
Monika L. Metzger ◽  
Sharon M. Castellino ◽  
Melissa M. Hudson ◽  
Shesh N. Rai ◽  
Sue C. Kaste ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Clinical Characteristics ◽  
Hemoglobin Concentration ◽  
Black Children ◽  
Hodgkin's Lymphoma ◽  
Event Free Survival ◽  
White Children ◽  
Free Survival ◽  
Black And White ◽  
Black Patients

Purpose Some cooperative groups have found a survival disadvantage in black children with various childhood cancers. We examine the effects of race on clinical outcomes among children with Hodgkin's lymphoma (HL) treated with contemporary therapy at a tertiary care children's hospital. Patients and Methods Retrospective analysis of 327 children and adolescents diagnosed with HL between 1990 and 2005. Patients were treated with risk-directed multimodal therapy regardless of race, ethnicity, or ability to pay. Event-free and overall survival rates were compared for black and white children. Clinical characteristics, socioeconomic factors, and biologic features were analyzed for prognosis of treatment failure. Results The 262 white and 65 black patients did not differ significantly in presenting features, clinical characteristics, or enrollment in a clinical trial. More black patients (71% v 45%) resided in poor counties (P < .001). While black and white children were equally likely to have progressive disease or early relapse, black children were 3.7 times (95% CI, 1.7 to 8.0) more likely to relapse 12 months or more after diagnosis. The 5-year event-free survival was 71% ± 6.1% (SE) for black and 84% ± 2.4% for white children (P = .01). However, the 5-year survival rate did not differ between white and black children (94.4% v 94.7%). While black race and low hemoglobin concentration were independent predictors of treatment failure, only low hemoglobin concentration independently predicted poor survival. Conclusion Black children with Hodgkin's lymphoma have lower event-free survival than white children, but both populations have the same 5-year overall survival.

ABVD Versus Modified Stanford V Versus MOPPEBVCAD With Optional and Limited Radiotherapy in Intermediate- and Advanced-Stage Hodgkin's Lymphoma: Final Results of a Multicenter Randomized Trial by the Intergruppo Italiano Linfomi

2005 ◽  
Vol 23 (36) ◽  
pp. 9198-9207 ◽  
Author(s):  
Paolo G. Gobbi ◽  
Alessandro Levis ◽  
Teodoro Chisesi ◽  
Chiara Broglia ◽  
Umberto Vitolo ◽  
...  
Keyword(s):  
Adjuvant Radiotherapy ◽  
Hodgkin’S Lymphoma ◽  
Response Rate ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Complete Response ◽  
Hodgkin's Lymphoma ◽  
Free Survival ◽  
Drug Doses ◽  
Advanced Hodgkin’S Lymphoma

Purpose In this multicenter, prospective, randomized clinical trial on advanced Hodgkin's lymphoma (HL), the efficacy and toxicity of two chemotherapy regimens, doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone (Stanford V) and mechlorethamine, vincristine, procarbazine, prednisone, epidoxirubicin, bleomycin, vinblastine, lomustine, doxorubicin, and vindesine (MOPPEBVCAD), were compared with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) as standard therapy to select which regimen would best support a reduced radiotherapy program, which was limited to ≤ two sites of either previous bulky or partially remitting disease (a modification of the original Stanford program). Patients and Methods Three hundred fifty-five patients with stage IIB, III, or IV HL were randomly assigned. Three hundred thirty-four patients were assessable for the study and received six cycles of ABVD (n = 122), three cycles of Stanford V (n = 107), or six cycles of MOPPEBVCAD (n = 106); radiotherapy was administered to 76, 71, and 50 patients in these three arms, respectively. Results The complete response rates for ABVD, Stanford V, and MOPPEBVCAD were 89%, 76% and 94%, respectively; 5-year failure-free survival (FFS) and progression-free survival rates were 78%, 54%, 81% and 85%, 73%, and 94%, respectively (P < .01 for comparison of Stanford V with the other two regimens). Corresponding 5-year overall survival rates were 90%, 82%, and 89% for ABVD, Stanford V, and MOPPEBVCAD, respectively. Stanford V was more myelotoxic than ABVD but less myelotoxic than MOPPEBVCAD, which had larger reductions in the prescribed drug doses. Conclusion When associated with conditioned and limited (not adjuvant) radiotherapy, ABVD and MOPPEBVCAD were superior to Stanford V chemotherapy in terms of response rate and FFS and progression-free survival. Patients were irradiated less often after MOPPEBVCAD, but this regimen was more toxic. ABVD is still the best choice when it is combined with optional, limited irradiation.

A Phase II Study of Yttrium-90-Ibritumomab Tiuxetan In Combination with a Fludarabine-Based Reduced Intensity Regimen Followed by Allogenic Stem Cell Transplantation In Patients with Relapsed or Chemorefractory CD 20 Positive Non-Hodgkin's Lymphoma.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4565-4565
Author(s):  
Krimo Bouabdallah ◽  
Sabine Furst ◽  
Reda Bouabdallah ◽  
Stephane Vigouroux ◽  
Reza Tabrizi ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Conditioning Regimen ◽  
Hodgkin's Lymphoma ◽  
Unrelated Donor ◽  
Event Free Survival ◽  
Ibritumomab Tiuxetan ◽  
Free Survival ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Bayer Healthcare

Abstract Abstract 4565 Background: The outcome of patients with relapsed or refractory non-Hodgkin's lymphoma (NHL) is very poor despite aggressive treatments or novel therapeutic agents. Allogenic STC (allo-STC) remains the only curative approach with an interesting reduced treatment-related-mortality (TRM) commonly associated with reduced intensity conditioning regimens (RIC). Radio immunotherapy (RIT) as part of conditioning regimen for autologous stem cell transplantion (ASCT) as well as for allo-SCT has demonstrated its safety and many studies are now suggesting an improved outcome. This phase II study (ClinicalTrials.gov: NCT 00607854) evaluated the safety and efficacy of Yttrium-90 ((90)-Y)-ibritumomab tiuxetan in combination with a fludarabine-based RIC followed by allo-SCT in patients with relapsed or chemorefractory CD 20 positive non-Hodgkin's lymphoma. Patients and Method: Patients with relapsed or refractory CD 20 positive NHL where eligible for the study if they had a sensitive disease (at least partial response) to the last salvage regimen and a suitable donor: related (RD) or unrelated donor (MUD or with a C or DQ mismatch). Each patient received a single dose of ((90)-Y)-ibritumomab tiuxetan (0,4 mci/Kg on day -14) followed from day -6 by a combination of fludarabine (30 mg/m2 d -6 to d -2), busilvex ((3,2 mg/Kg d -5 and d -4) and antithymocyte globulin (2,5 mg/Kg d -1). GVH prophylaxis was based on cyclosporine (CsA) alone or in combination with methotrexate (Mtx) in case of mismatched unrelated donor. The trial was designed to enroll 30 evaluable pts and the study started on January 2008. At time of this writing, 27 pts have been included and we report the preliminary results of the first 14 consecutive pts. The primary objective (PO) of the study was to evaluate the day 100 TRM. Secondary objectives were response (CR, PR) and event-free survival at 1 year. RESULTS: Fourteen pts are evaluable for the PO. The median age was 55 years (35-60), and the sex ratio (M/F) 10/4. Prior disease was DLBCL (5), MCL (4), FL (5). Pts received a median number of 2 previous treatment regimens and all pts had undergone ASCT before. Median time between diagnosis and allo-SCT and between ASCT and allo-SCT were 39 mo (range 8 – 106) and 14, 5 mo (range 3–52) respectively. At time of transplant 10 pts were in CR and 4 in PR. There were 10 RD and 4 MUD transplants. All pts received peripheral blood stem cells transplantation and GVH prophylaxis with CsA alone. Two pts died from a-GVH at day 40 and 117 post-transplant respectively with a TRM at day 100 of 7%. Both were in CR. The median time to ANC engraftment (ANC > 500/mm3) was 17 days (range 12 – 22) and time to platelets engraftment (Plt > 20.000/mm3) was 11 days (range 0–16). Acute GVH occurred in 7 pts with only 3 pts with grade ≥ 2. At day 100 after transplantation, 8 out of the 10 (80%) evaluable pts achieved a complete T-cell donor chimerism. With a median follow-up of 10 month (range 6 – 26), 12 pts are alive and in CR. The estimated event-free survival at 1year is 86% (CI 78% - 94%). CONCLUSION: ((90)-Y)-ibritumomab tiuxetan is safe and well tolerated when used in combination with a fludarabine-based RIC regime. Preliminary data suggest that the TRM is not increased by adding RIT in this conditioning regimen. Disclosures: Bouabdallah: Bayer Healthcare: The Trial has been partially sponsored by Bayer Healthcare. Off Label Use: Zevalin is off-label use in conditioning regimen in France.

scholarly journals Intensive chemotherapy in children with acute lymphoblastic leukemia. Interim analysis in a referral center in Colombia.

2016 ◽  
Vol 64 (3) ◽  
pp. 417 ◽  
Author(s):  
Angela Maria Trujillo ◽  
Adriana Linares Ballesteros ◽  
Isabel Cristina Sarmiento
Keyword(s):  
Overall Survival ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Survival Rates ◽  
Developed Countries ◽  
Event Free Survival ◽  
Free Survival ◽  
Grade 3 ◽  
Treatment Abandonment ◽  
Cancer In Children

Background: Acute lymphoblastic leukemia is the most common cancer in children. In developed countries, overall survival rates are around 80%, while in developing countries, survival rate is much lower due to high rates of relapse, and abandonment and complications arising from the disease treatment.Objectives: To assess induction mortality, relapse and treatment abandonment. To describe the most frequent side effects of chemotherapy. To evaluate survival rates of patients and compare the findings found in this study with the existing literature.Material and methods: A retrospective cohort study was conducted on patients aged 1 to 18 with acute lymphoblastic leukemia, who received treatment under the BFM ALL IC 2009 protocol at Fundación Hospital La Misericordia (HOMI), from November 2012 to December 2014.Results: 119 patients were included. Death occurred in two cases during induction (1.67%) and in nine (7.7%) due to treatment, all of them caused by infection/sepsis and in complete remission. Six patients abandoned treatment (5%), while seven relapses occurred (5.9%). All patients experienced some type of side effect related to chemotherapy, the most frequent being febrile neutropenia (41.2%) and grade 3-4 infections (15.8%). Overall survival and event-free survival rates were 79.9% and 73.3%, respectively.Conclusions: Evaluating complications of treatment and death allows adopting measures and strategies to reduce such complications.

scholarly journals Pediatric-Based Versus Adult Treatment Protocols in Young Adults (18-40 years) with Standard Risk Acute Lymphoblastic Leukemia: The BC Cancer Agency Experience

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3770-3770 ◽  
Author(s):  
David Simon Kliman ◽  
Michael J Barnett ◽  
Raewyn Broady ◽  
Donna L. Forrest ◽  
Alina S. Gerrie ◽  
...  
Keyword(s):  
British Columbia ◽  
Overall Survival ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Survival Rates ◽  
High Dose ◽  
Event Free Survival ◽  
Free Survival ◽  
Small Cohort ◽  
Standard Risk

Abstract Introduction In recent decades, overall survival rates for children with acute lymphoblastic leukemia (ALL) have improved dramatically. Unfortunately, older patients have not experienced the same benefit. Recent years have seen investigation into the use of pediatric protocols for younger adults with ALL. Increased toxicity has often limited use to patients 40 years or younger. The Leukemia/Bone Marrow Transplant Program of BC is the referral center for adults with ALL in British Columbia. Approximately 20 patients are newly diagnosed with ALL each year. Until 2008, an adult protocol (known as ALL 89-1) was used in patients over 18 years. Since 2008, pediatric-based chemotherapy has been offered to patients 40 years or younger. We analyzed whether this change altered complete remission (CR), relapse and survival rates. We assessed whether the more intense protocol increased toxicity. Methods A retrospective analysis was performed on patients treated for ALL on a pediatric-based protocol. These protocols (ALL 08-01 and ALL 13-01) were modifications of the Donna Farber Cancer Institute 01-175 protocol. The format included induction with high dose methotrexate, followed by central nervous system (CNS) therapy including cranial irradiation. A single cycle of etoposide and high-dose cytarabine was given. Consolidation and continuation cycles included doxorubicin, asparaginase, vincristine and dexamethasone. Patients were included if they were aged 18-40 years and had standard risk, Philadelphia chromosome negative ALL. Between February 2008 and November 2014, 25 eligible patients were identified. These were compared with the 23 consecutive standard risk patients most recently treated with ALL 89-1. They had been diagnosed between February 2003 and July 2008. Exclusion criteria were age greater than 40 and non-standard risk ALL. Demographic and clinical data were collected on all patients from the Leukemia Program databases. Overall survival (OS) was calculated from time of diagnosis until death. Event free survival (EFS) was calculated from diagnosis until death, induction failure or relapse. Estimation of OS and EFS was performed using the Kaplan-Meier method. Patient characteristics were compared using Chi-squared test or Fisher's exact test. Ethics approval was obtained from the University of British Columbia ethics board. Results The median age of the combined patient group was 24.5 years. There were no statistically significant differences pre-treatment between groups. Combined median follow up was 28.7 months All 25 patients receiving a pediatric protocol achieved a CR, compared to 19 of 22 with the adult protocol. Despite the more intense chemotherapy dosing regimen in the pediatric protocol, there was no increase in hospitalizations, invasive fungal infections or deaths from treatment toxicity (Table 1). There was a trend towards increased thrombotic events in the pediatric-treated group, at 32% versus 9%. These included deep vein thrombosis in 4 patients, pulmonary emboli in 2, and cerebral sinus thrombosis in 2. Relapse occurred in 24% of the pediatric-treated patients and 45% of the adult-treated ones (p=0.215). Allogeneic stem cell transplantation was performed in 4 patients in the former group and 7 in the latter. Nine of these were carried out in CR2 or later, with two patients going into transplant with active disease. Overall survival following transplant was 44%. Two year event free survival was significantly improved in the group treated on the pediatric protocol (Figure 1), at 79% versus 36% (p=0.011). There was a trend towards improved overall survival in this small cohort, at 83% versus 49% (Figure 2). Conclusions A pediatric-based ALL treatment protocol was tolerated in patients up to the age of 40 years. In our centre, this is associated with an increase in EFS, and a trend towards increased OS, even considering the small cohort. We await with interest the results of larger studies investigating the ideal upfront therapy for young patients with ALL. Table 1. Results All Patients N=47 Adult N=22 Pediatric N=25 P Number % Number % Number % CR after induction 44 of 47 94 19 of 22 86 25 of 25 100 .095 Severe infection 20 of 47 43 9 of 22 41 11 of 25 44 .831 Thrombosis 10 of 47 21 2 of 22 9 8 of 25 32 .079 Pancreatitis 2 of 47 4 0 of 22 0 2 of 25 8 .491 Toxicity deaths 3 of 47 6 2 of 22 9 1 of 25 4 .593 Relapse 16 of 47 34 10 of 22 45 6 of 25 24 .215 AlloHSCT 11 of 47 23 7 of 22 32 4 of 25 16 .303 Disclosures No relevant conflicts of interest to declare.

scholarly journals Improved Prognosis for Older Adolescents With Acute Lymphoblastic Leukemia

2011 ◽  
Vol 29 (4) ◽  
pp. 386-391 ◽  
Author(s):  
Ching-Hon Pui ◽  
Deqing Pei ◽  
Dario Campana ◽  
W. Paul Bowman ◽  
John T. Sandlund ◽  
...  
Keyword(s):  
Overall Survival ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Survival Rates ◽  
Event Free Survival ◽  
Free Survival ◽  
Younger Patients ◽  
Older Adolescents ◽  
Total Therapy ◽  
Therapy Studies

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.

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