Adolescents and young adults are at greater risk of relapse than children with acute lymphoblastic leukemia (ALL). The lack of participation in a clinical trial and a shorter duration of treatment are risk factors for this relapse.
The improvement in survival rates for acute lymphoblastic leukemia has been dramatic in children, but remains less in adolescents and young adults. To address this disparity, the National Cancer Institute (NCI) has created a special designation for this particular population: “Adolescent and Young Adult” (AYA) and is promoting research to determine why these patients often have poorer outcomes. acute leukemia.
As previous research had indicated, in one of these studies it was clear that children with ALL have a better relapse-free survival than adolescents and young adults.
Five years after diagnosis, 74% of children have not relapsed or died, compared to 29% of the youngest AYA (15-21 years) and 32% of the oldest (22-39 years). The results are published in Cancer Epidemiology, Biomarkers & Prevention.
A registry of acute lymphoblastic leukemia
The researchers assembled a retrospective cohort of all patients diagnosed with acute lymphoblastic leukemia between the ages of 1 and 39 and treated at City of Hope between 1990 and 2010, a cancer treatment center designated by the NCI.
In total, 91 patients are children aged 1 to 14 years and 93 are AYA (15 to 39 years). The researchers analyzed variables such as demographics, insurance status, patient participation in a clinical trial, duration of treatment, but also whether patients were treated with “pediatric-inspired” or “pediatric-inspired” regimens. of adult inspiration “.
Indeed, whether adolescents and young adults with acute lymphoblastic leukemia are treated more as pediatric patients or as adults is often simply determined by the hospital in which they receive their treatment.
Additional results
Forty-eight percent of AYAs relapse while on treatment, compared to 17% of children. Among these patients, the strongest predictors of relapse are race (nonwhite patients are twice as likely to relapse) and clinical trial participation (those who were not included are 2.6 times more at risk of relapse).
After the end of treatment, 47% of AYAs relapse, compared to 13% of children. Among these patients, the most important factor is the duration of treatment, both in the consolidation and maintenance phases. For each month of additional maintenance treatment, the risk of relapse is 30% lower.
Better study adolescents and young adults
This study demonstrates that adolescents and young adults should be encouraged to participate in clinical trials appropriate to their age when diagnosed with ALL. Ideally, an AYA patient who has been diagnosed with ALL should be made aware of the availability of a clinical trial for them, either in the hospital where they are to be treated first or in another center.
Indeed, participation in clinical trials confers multiple advantages, not only because the tested treatment can be better, but also because it is about a more rigorous approach and adjusted according to precise markers.
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