St Jude Children's Research Hospital, Memphis, TN 38105, USA.
J Clin Oncol. 2011 Feb 1;29(4):386-91. doi: 10.1200/JCO.2010.32.0325. Epub 2010 Dec 20.
The prognosis for older adolescents and young adults with acute lymphoblastic leukemia (ALL) has been historically much worse than that for younger patients. We reviewed the outcome of older adolescents (age 15 to 18 years) treated in four consecutive Total Therapy studies to determine if recent improved treatment extended to this high-risk group.
Between 1991 and 2007, 963 pediatric patients, including 89 older adolescents, were enrolled on Total Therapy studies XIIIA, XIIIB, XIV, and XV. In the first three studies, treatment selection was based on presenting clinical features and leukemic cell genetics. In study XV, the level of residual disease was used to guide treatment, which featured intensive methotrexate, glucocorticoid, vincristine, and asparaginase, as well as early triple intrathecal therapy for higher-risk ALL.
The 89 older adolescents were significantly more likely to have T-cell ALL, the t(4;11)(MLL-AF4), and detectable minimal residual disease during or at the end of remission induction; they were less likely to have the t(12;21)(ETV6-RUNX1) compared with younger patients. In the first three studies, the 44 older adolescents had significantly poorer event-free survival and overall survival than the 403 younger patients. This gap in prognosis was abolished in study XV: event-free survival rates at 5 years were 86.4% ± 5.2% (standard error) for the 45 older adolescents and 87.4% ± 1.7% for the 453 younger patients; overall survival rates were 87.9% ± 5.1% versus 94.1% ± 1.2%, respectively.
Most older adolescents with ALL can be cured with risk-adjusted intensive chemotherapy without stem-cell transplantation.
与年轻患者相比，急性淋巴细胞白血病（ALL）老年青少年和年轻成人的预后一直较差。我们回顾了在四项连续的总治疗研究中接受治疗的老年青少年（15 至 18 岁）的结果，以确定最近改善的治疗方法是否扩展到这一高危人群。
1991 年至 2007 年，共有 963 名儿科患者，包括 89 名青少年，参加了总治疗研究 XIII、XIIIb、XIV 和 XV。在前三项研究中，治疗选择基于临床表现和白血病细胞遗传学。在研究 XV 中，残留疾病水平用于指导治疗，其特点是使用大剂量甲氨蝶呤、糖皮质激素、长春新碱和门冬酰胺酶，以及早期三重鞘内治疗高危 ALL。
89 名青少年患者更有可能患有 T 细胞 ALL、t(4;11)(MLL-AF4)和缓解诱导期间或结束时可检测到的微小残留疾病；与年轻患者相比，他们不太可能患有 t(12;21)(ETV6-RUNX1)。在前三项研究中，44 名青少年患者的无事件生存和总生存明显低于 403 名年轻患者。在研究 XV 中，这种预后差距被消除：45 名青少年患者的 5 年无事件生存率为 86.4%±5.2%（标准误差），453 名年轻患者为 87.4%±1.7%；总生存率分别为 87.9%±5.1%和 94.1%±1.2%。
大多数患有 ALL 的青少年患者可以通过风险调整的强化化疗而无需干细胞移植来治愈。
