Adolescents and young adults with acute lymphoblastic leukemia have a better outcome when treated with pediatric-inspired regimens: Systematic review and meta-analysis

Authors

  • Ron Ram,

    Corresponding author
    1. Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel
    2. Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
    • Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
    Search for more papers by this author
  • Ofir Wolach,

    1. Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel
    2. Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
    Search for more papers by this author
    • Conflict of interests: Nothing to report.

  • Liat Vidal,

    1. Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel
    2. Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
    Search for more papers by this author
  • Anat Gafter-Gvili,

    1. Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel
    2. Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
    Search for more papers by this author
  • Ofer Shpilberg,

    1. Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel
    2. Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
    Search for more papers by this author
  • Pia Raanani

    1. Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel
    2. Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
    Search for more papers by this author

  • R.R. and O.W. contributed equally to this work.

Abstract

Survival of adults with acute lymphoblastic leukemia (ALL) is inferior to that of pediatric patients. Strategies to improve the outcome of adult population are warranted. This study aims to evaluate the efficacy and safety of pediatric-inspired regimens given to adolescents and young adults (AYA), usually defined as 16–39 years, with ALL. Systematic review and meta-analysis of comparative trials of AYA patients with ALL given induction chemotherapy with either pediatric-inspired regimens or conventional-adult chemotherapy was conducted. Relative risks (RR) with 95% confidence intervals (CIs) were estimated and pooled. Our search yielded 11 trials, including 2,489 patients. AYA patients given pediatric-inspired regimens had a statistically significant lower all cause mortality rate at 3 years (RR 0.58; 95% CI 0.51–0.67). Complete remission rate after induction chemotherapy and event free survival were superior in the pediatric-inspired regimens arm (RR 1.05; 95% CI 1.01–1.10 and RR 1.66; 95% CI 1.39–1.99, respectively). Relapse rate was also lower in patients given pediatric-inspired regimens (RR 0.51; 95% CI 0.39–0.66) with comparable nonrelapse mortality between the two groups (RR 0.53, 95% CI 0.19–1.48). Pediatric-inspired regimens are superior to conventional-adult chemotherapy in AYA ALL patients. Further randomized controlled studies to investigate this approach in adult ALL patients are warranted. Am. J. Hematol. 87:472–478, 2012. © 2012 Wiley Periodicals, Inc.

Ancillary