Abstract
Abstract 2591
Survival of adults with acute lymphoblastic leukemia (ALL) is inferior to pediatric patients. Therefore, strategies to improve long-term results in this population are warranted. Objectives: This study aims to evaluate the efficacy and safety of pediatric-inspired regimens given to adolescents and young adults (AYA) with ALL. Methods: 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. Cochrane Library, MEDLINE and conference proceedings were searched (up-to May, 2011). Outcomes assessed were: all-cause mortality, number of patients achieving complete remission after induction chemotherapy and toxicity of the regimen (evaluated by non-relapse mortality). Relative risks (RR) with 95% confidence intervals (CIs) were estimated and pooled. Results: Our search yielded 11 trials, including 2489 patients. The age of AYA patients ranged between 10 and 57 years. Studies were published between the years 2003 and 2009. AYA patients given pediatric-inspired regimens had a statistically significant lower all cause mortality at 3 years (RR 0.58; 95% CI 0.51–0.79, 7 trials) beyond 3 years (RR 0.58; 95% CI 0.51–0.65, 8 trials) and at the end of study period (RR 0.59; 95% CI 0.52–0.66, 9 trials, Figure). Sensitivity analysis for all cause mortality including studies in which the two cohorts were well compared in either age or disease risk also showed decreased all cause mortality in patients given pediatric-inspired regimen (RR 0.53; 95% CI 0.41–0.70, I2=50%, 4 trials). However, this superiority in survival for pediatric-inspired regimens was not maintained when studies including only patients older than 20 years were analyzed (RR 0.49; 95% CI 0.23–1.06, I2=67%, 2 trials). Complete remission rate after induction chemotherapy was superior in patients given pediatric-inspired regimens when compared to patients given conventional adult chemotherapy (RR 1.05; 95% CI 1.01–1.10, I2=55%, 7 trials) with comparable non-relapse mortality in both groups (RR 0.53; 95% CI 0.19–1.48, I2=56%, 4 trials). Conclusions: For patients up to the age of 20 years, pediatric-inspired regimens are superior to conventional adult chemotherapy in terms of ACM and complete remission rate with similar non relapse mortality. Randomized controlled trials to further investigate the feasibility of this approach in adult ALL patients are warranted.
No relevant conflicts of interest to declare.
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