What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols?
We performed a retrospective comparison of presenting features, planned treatment, complete remission (CR) rate and outcome of 321 adolescents and young adults (AYAs) 16-20 years of age with newly diagnosed acute lymphoblastic leukemia (ALL) who were treated on consecutive trials in either the CCG or the CALGB during 1988-2001. CR rates were identical, 90% for both CALGB and CCG AYAs. CCG AYAs had a 63% event free survival (EFS) and 67% overall survival (OS) at 7 years in contrast to the CALGB AYAs where 7-year EFS was only 34% (p <0.0001; RHR = 2.2) and OS was 46% (p = 0.0002; RHR = 1.9). While CALGB AYAs 16-17 years old achieved similar outcomes to all CCG AYAs with a 7-year EFS of 55%, the EFS for 18-20 year old CALGB patients was only 29%. Comparison of the regimens showed that CCG AYAs received earlier and more intensive central nervous system prophylaxis and higher cumulative doses of non-myelosuppressive agents. There were no differences in outcomes of those who reached maintena
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