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Treating Young Adults with Acute Lymphoblastic Leukemia: Is this progress? M. Rytting, M.D. M.D. Anderson Cancer Center
<ul><li>Why have a trial of therapy for ALL in this population?  </li></ul><ul><li>What therapy should be the standard arm...
Cancers in Young Adults, Age 15-19 Years  SEER, 1975-1998, U.S. Lymphoma Leukemia Germ Cell Sarcoma Brain 7% Testis 9% Ova...
 
National Cancer Mortality Reduction 1990-1998 Age (Years) 2.8% 2.6% 1.8% 0.9% 1.5% 0.4% 1.1% 1.5% 0% 1% 3% 2% Average Annu...
 
ALL in AYA Patients <ul><li>What age range should be targeted? </li></ul><ul><ul><li>Pediatric evidence supports at least ...
Adult Trials in ALL <ul><li>ALL represents about 1% of adult malignancy </li></ul><ul><li>Stratification by age not usuall...
Larson R, et al. Blood 1998, 92: 1556.
Rowe JM, et al. Blood 2005, 106: 3760.
Copyright ©2005 American Society of Hematology.  Copyright restrictions may apply. Overall survival by age Rowe, J. M. et ...
MDACC curve
. Thomas X et al. JCO 2004;22:4075-4086 ©2004 by American Society of Clinical Oncology
Adult Trials with Modifications
Outcomes by therapy for younger patients (age younger than 60 years) with Philadelphia chromosome–negative precursor B-lin...
Retrospective Analysis of the Adolescent/Young Adult Experience
 
 
 
 
Copyright ©2008 Ferrata Storti Foundation Usvasalo, A. et al. Haematologica 2008;93:1161-1168 (A) Event-free survival (EFS...
Recent Pediatric Trial Results for Adolescents with ALL
 
 
Applying Pediatric-based Therapy to Young Adults with ALL  <ul><li>There are currently a handful of published studies, and...
. Ribera J et al. JCO 2008;26:1843-1849 ©2008 by American Society of Clinical Oncology
Event-free survival (EFS) and overall survival (OS). Huguet F et al. JCO 2009;27:911-918 ©2009 by American Society of Clin...
Chang J, et al. Leukemia and Lymphoma, 2008; 49(12):2298
So, start a trial. <ul><li>What regimen to use?  </li></ul><ul><li>Obstacles </li></ul><ul><li>Compliance (patient and phy...
 
 
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  1. 1. Treating Young Adults with Acute Lymphoblastic Leukemia: Is this progress? M. Rytting, M.D. M.D. Anderson Cancer Center
  2. 2. <ul><li>Why have a trial of therapy for ALL in this population? </li></ul><ul><li>What therapy should be the standard arm? </li></ul><ul><li>After the first trial, what is next? </li></ul>
  3. 3. Cancers in Young Adults, Age 15-19 Years SEER, 1975-1998, U.S. Lymphoma Leukemia Germ Cell Sarcoma Brain 7% Testis 9% Ovary 7% Hodgkin's 16% NHL 8% ALL 6% AML 5% CNS 10% Soft Tissue Sa 7% Osteosarcoma 5% Ewing's 2% Melanoma 7% Thyroid Other 12%
  4. 5. National Cancer Mortality Reduction 1990-1998 Age (Years) 2.8% 2.6% 1.8% 0.9% 1.5% 0.4% 1.1% 1.5% 0% 1% 3% 2% Average Annual % Reduction 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39
  5. 7. ALL in AYA Patients <ul><li>What age range should be targeted? </li></ul><ul><ul><li>Pediatric evidence supports at least up to age 21 </li></ul></ul><ul><li>Above 21 and under __?__ is the experimental group </li></ul><ul><li>This group is generally going to be underinsured </li></ul><ul><li>They do not go to pediatric clinics or hospitals (though some of them could fool you) </li></ul>
  6. 8. Adult Trials in ALL <ul><li>ALL represents about 1% of adult malignancy </li></ul><ul><li>Stratification by age not usually done or reported </li></ul><ul><li>The cure rate for all adults as a group is consistently around 40% </li></ul>
  7. 9. Larson R, et al. Blood 1998, 92: 1556.
  8. 10. Rowe JM, et al. Blood 2005, 106: 3760.
  9. 11. Copyright ©2005 American Society of Hematology. Copyright restrictions may apply. Overall survival by age Rowe, J. M. et al. Blood 2005;106:3760-3767
  10. 12. MDACC curve
  11. 13. . Thomas X et al. JCO 2004;22:4075-4086 ©2004 by American Society of Clinical Oncology
  12. 14. Adult Trials with Modifications
  13. 15. Outcomes by therapy for younger patients (age younger than 60 years) with Philadelphia chromosome–negative precursor B-lineage acute lymphoblastic leukemia. Thomas D A et al. JCO 2010;28:3880-3889 ©2010 by American Society of Clinical Oncology
  14. 16. Retrospective Analysis of the Adolescent/Young Adult Experience
  15. 21. Copyright ©2008 Ferrata Storti Foundation Usvasalo, A. et al. Haematologica 2008;93:1161-1168 (A) Event-free survival (EFS) and (B) overall survival (OS) of the study patients treated with pediatric and adult protocols
  16. 22. Recent Pediatric Trial Results for Adolescents with ALL
  17. 25. Applying Pediatric-based Therapy to Young Adults with ALL <ul><li>There are currently a handful of published studies, and the number is growing </li></ul><ul><ul><li>Some ongoing studies are currently in abstract form </li></ul></ul><ul><li>How many randomized? </li></ul><ul><li>Patient characteristics? </li></ul><ul><li>Subsets that do better? </li></ul>
  18. 26. . Ribera J et al. JCO 2008;26:1843-1849 ©2008 by American Society of Clinical Oncology
  19. 27. Event-free survival (EFS) and overall survival (OS). Huguet F et al. JCO 2009;27:911-918 ©2009 by American Society of Clinical Oncology
  20. 28. Chang J, et al. Leukemia and Lymphoma, 2008; 49(12):2298
  21. 29. So, start a trial. <ul><li>What regimen to use? </li></ul><ul><li>Obstacles </li></ul><ul><li>Compliance (patient and physician) </li></ul><ul><li>Insurance </li></ul><ul><li>Funding? </li></ul>

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