Treatment completion, asparaginase completion, and oncologic outcomes among children, adolescents and young adults with acute lymphoblastic leukemia treated with DFCI Consortium Protocols Journal Article
| Authors: | Valtis, Y. K.; Flamand, Y.; Shimony, S.; Place, A. E.; Silverman, L. B.; Vrooman, L. M.; Brunner, A. M.; Sallan, S. E.; Wadleigh, M.; Stone, R. M.; DeAngelo, D. J.; Luskin, M. R. |
| Article Title: | Treatment completion, asparaginase completion, and oncologic outcomes among children, adolescents and young adults with acute lymphoblastic leukemia treated with DFCI Consortium Protocols |
| Abstract: | Adolescents and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) face worse outcomes than children. While pediatric-inspired protocols have improved outcomes, the ability of patients to complete these intensive regimens and the reasons for discontinuation are unknown. We analyzed a cohort of 332 AYA patients (aged 15–49 years) and 1159 children (aged 1–14 years) with Ph-negative ALL treated on DFCI consortium protocols. We found that AYA patients completed treatment at lower rates than children (60.8% vs. 89.7%, p < 0.001), primarily due to higher rates of early treatment failure (14.5% vs. 2.4%, p < 0.001). Withdrawal from treatment for toxicity, social/personal, or unknown reasons was uncommon, but higher among AYA patients (9.3% vs 4.7%, p = 0.001). Patients who remained on assigned therapy for one year had favorable overall survival (AYA 5-year OS 88.9%; children 5-year OS 96.4%; p < 0.001). Among patients who continued treatment for 1 year, AYA patients completed asparaginase (defined as receiving 26+ weeks) at lower rates than children (79.1% vs. 89.6%, p < 0.001). Patients who received more weeks of consolidation asparaginase had higher overall and event-free survival. Efforts should focus on identifying patients at risk for early treatment failure and optimizing asparaginase delivery. © The Author(s), under exclusive licence to Springer Nature Limited 2024. |
| Keywords: | adolescent; adult; child; event free survival; survival analysis; survival rate; treatment failure; young adult; human cell; major clinical study; overall survival; clinical feature; drug withdrawal; treatment duration; antineoplastic agent; antineoplastic combined chemotherapy protocols; prevalence; cohort analysis; retrospective study; acute lymphoblastic leukemia; correlation analysis; asparaginase; precursor cell lymphoblastic leukemia-lymphoma; drug substitution; clinical outcome; treatment protocol; humans; human; male; female; article |
| Journal Title: | Leukemia |
| Volume: | 38 |
| Issue: | 3 |
| ISSN: | 0887-6924 |
| Publisher: | Nature Publishing Group |
| Date Published: | 2024-01-01 |
| Start Page: | 482 |
| End Page: | 490 |
| Language: | English |
| DOI: | 10.1038/s41375-023-02115-4 |
| PUBMED: | 38177437 |
| PROVIDER: | scopus |
| PMCID: | PMC11656463 |
| DOI/URL: | |
| Notes: | Article -- Source: MSK author Ionnis Valtis's first name is spelled Yannis on the original publication -- copus |
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