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Favorable Outcome for Adolescents With Acute Lymphoblastic Leukemia Treated on Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium Protocols

Elly Barry, Daniel J. DeAngelo, Donna Neuberg, Kristen Stevenson, Mignon L. Loh, Barbara L. Asselin, Ronald D. Barr, Luis A. Clavell, Craig A. Hurwitz, Albert Moghrabi, Yvan Samson, Marshall Schorin, Harvey J. Cohen, Stephen E. Sallan, Lewis B. Silverman

From Departments of Pediatric Oncology, Medical Oncology, and Biostatistical Science, Dana-Farber Cancer Institute; Department of Pediatrics, Children's Hospital; Harvard Medical School, Boston, MA; Department of Pediatric Hematology-Oncology, University of California, San Francisco; Department of Pediatrics, Lucile Packard Children’s Hospital, Palo Alto, CA; Department of Pediatric Hematology-Oncology, Hospital Sainte Justine, Montréal; Department of Pediatrics, Centre Hospitalier Universitaire de Québec, Québec; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Pediatric Hematology-Oncology, University of Rochester Medical Center, Rochester, NY; Department of Pediatric Oncology, San Jorge Children's Hospital, San Juan, Puerto Rico; Department of Pediatric Oncology, Maine Children's Cancer Program at Maine Medial Center, Portland, ME; and Department of Pediatrics, Tulane Hospital for Children, New Orleans, LA

Address reprint requests to Elly Barry, MD, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115; e-mail: elly_barry{at}dfci.harvard.edu

Purpose: Historically, adolescents with acute lymphoblastic leukemia (ALL) have had inferior outcomes when compared with younger children. We report the outcome of adolescents treated on Dana-Farber Cancer Institute (DFCI; Boston, MA) ALL Consortium Protocols conducted between 1991 and 2000.

Patients and Methods: A total of 844 patients aged 1 to 18 years, with newly diagnosed ALL were enrolled onto two consecutive DFCI-ALL Consortium Protocols. We compared outcomes in three age groups: children aged 1 to 10 years (n = 685), young adolescents aged 10 to 15 years (n = 108), and older adolescents aged 15 to 18 years (n = 51).

Results: With a median follow-up of 6.5 years, the 5-year event-free survival (EFS) for those aged 1 to 10 years was 85% (SE, 1%), compared with 77% (SE, 4%) for those aged 10 to 15 years, and 78% (SE, 6%) for those aged 15 to 18 years (P = .09). Adolescents were more likely to present with T-cell phenotype (P < .001) and less likely to have the TEL-AML1 fusion (P = .05). The incidence of pancreatitis and thromboembolic complications, but not asparaginase allergy, was higher in patients 10 years of age compared with those younger than 10 years. However, there was no difference in the rate of treatment-related complications between the 10- to 15-year and 15- to 18-year age groups.

Conclusion: Adolescents were more likely to present at diagnosis with biologically higher risk disease (T-cell phenotype and absence of the TEL-AML1 fusion) and more likely to experience treatment-related complications than younger children. However, the 5-year EFS for older adolescents was 78% ± 6%, which is superior to published outcomes for similarly aged patients treated with other pediatric and adult ALL regimens. Based on this experience, we currently are piloting our regimen in patients aged 18 to 50 years.

Supported by Grant No. CA 68484 from the National Institutes of Health.

Presented in part at the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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