Acute Myeloid Leukemia in Adolescents and Young Adults (AYAs): A Comparison of Outcomes Between Patients Treated on Childhood or Adult Protocols

Reviewer: Mary Kara Bucci, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: December 10, 2001

Presenter: William G. Woods
Presenter's Affiliation: Emory University, Atlants, GA and Children's Cancer Group, Arcadia, CA
Type of Session: Scientific

Background
Children with AML are frequently treated with more aggressive regimens than adults, and adults under age 40 are often treated with more aggressive regimens than older adults due to increased treatment-related mortality (TRM). Adolescents and young adults (AYAs) can have the acute, proliferative form of AML often seen in children, yet are often treated on adult protocols. It is unknown whether this produces a difference in outcome in this population. This study compares previously untreated AYAs age 16-21 treated on the superior arm of a pediatric protocol with those treated on adult protocols from a single instituion.

Materials and Methods

Patients (pts) age 16-21 from the intensive timing arm of Children's Cancer Group (CCG) 2891 (n=59) were compared with patients of the same age treated at the MD Anderson Cancer Center (MDACC) on adult protocols between 1980 and 2000 (n=54).

Regimens used at MDACC include AraC/daunorubicin (1980-85), high dose AraC with or without an antracycline (1986-93), high dose AraC + Fludarabine +/- an anthracyclin (1994-96), AraC + Topotecan +/- cyclophosphamide (1996-2000).

Patient groups were similar with regard to all known prognostic factors except for minor differences in age (median 18.9 for MDACC pts vs. 17.2 for CCG pts) and median bone marrow blast percentage (66% for MDACC pts vs. 76% for CCG pts).

Results

At 5 years from diagnosis, event-free survival was 17% for MDACC pts and 47% for CCG pts, p=.007.

At 5 years from remission, disease-free survival was 22% for MDACC pts and 60% for CCG pts, p=.003.

At 5 years from diagnosis, overall survival was 32% for MDACC pts and 51% for CCG pts, p=.16.

At 5 years from remission, overall survival was 41% for MDACC pts and 64% for CCG pts, p=.08.

The CCG 2891 trial found no difference in survival between pts under age 16 and pts 16-21.

MDACC pts 16-21 had similar survival to MDACC pts 21-41, and to the standard timing arm from CCG.

Author's Conclusions
The authors conclude that patients 16 - 21 years old treated according to the intensive timing arm of CCG 2891 fared better than those treated on the adult regimens of MDACC. Patients from this age group fared as well on adult regimens as those treated on inferior (standard timing) arm of CCG 2891.

Clinical/Scientific Implications
This retrospective study suggests that adolescents and young adults aged 16-21 have an improved outcome on more intensive regimens. Adult cancer centers may enroll patients of this age group of intergroup pediatric trials. In the future, more intensive therapy may be directed towards adults under age 45, as well.

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