Outcome of Adolescents and Young Adults With Acute Myeloid Leukemia Treated on COG Trials Compared to CALGB and SWOG Trials

• Type of Material: Article
• Authors: William G Woods, Emory University; Anna R.K. Franklin, University of Texas MD Anderson Cancer Center; Todd A. Alonzo, Children's Oncology Group Statistics Center; Robert B. Gerbing, Children's Oncology Group Statistics Center; Kathleen A. Donohue, CALGB Statistics Center; Megan Othus, Southwest Oncology Group Statistical Center; John Horan, Emory University; Frederick R. Appelbaum, Fred Hutchinson Cancer Research Center; Elihu H. Estey, Fred Hutchinson Cancer Research Center; Clara D. Bloomfield, Ohio State University; Richard A. Larson, University of Chicago
• Language: English
• Date: 2013-12-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 American Cancer Society.
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.28344
• Title of Journal or Parent Work: Cancer
• ISSN: 0008-543X
• Volume: 119
• Issue: 23
• Start Page: 4170
• End Page: 4179
• Grant/Funding Information: Generously funded by a grant from the Young Adult Alliance of the LIVESTRONG Foundation; The Coleman Leukemia Research Foundation; and Grants U10_CA98543, CA98413, CA101140, CA77658, CA31946, CA41287, CA32102, and CA38926 from the National Cancer Institute
• Keywords: AGE; Life Sciences & Biomedicine; young adults; CHILDRENS CANCER GROUP; HIGH-DOSE CYTARABINE; INTENSIVE POSTREMISSION CHEMOTHERAPY; acute myeloid leukemia; SOUTHWEST-ONCOLOGY-GROUP; Science & Technology; Oncology; GROUP-B; antineoplastic combined chemotherapy protocols; ACUTE LYMPHOBLASTIC-LEUKEMIA; INDUCTION THERAPY; adolescents; BONE-MARROW-TRANSPLANTATION; CUMULATIVE INCIDENCE
• Research Categories: Health Sciences, Oncology

Abstract

BACKGROUND A retrospective meta-analysis of adolescents and young adults (AYAs) with acute myeloid leukemia (AML) was performed to determine if differences in outcome exist following treatment on pediatric versus adult oncology treatment regimens. METHODS Outcomes were compared of 517 AYAs with AML aged 16 to 21 years who were treated on Children's Oncology Group (COG), Cancer and Leukemia Group B (CALGB), and Southwest Oncology Group (SWOG) frontline AML trials from 1986 to 2008. RESULTS There was a significant age difference between AYA cohorts in the COG, CALGB, and SWOG trials (median, 17.2 versus 20.1 versus 19.8 years, P <.001). The 10-year event-free survival of the COG cohort was superior to the combined adult cohorts (38% ± 6% versus 23% ± 6%, log-rank P =.006) as was overall survival (45% ± 6% versus 34% ± 7%), with a 10-year estimate comparison of P =.026. However, the younger age of the COG cohort is confounding, with all patients aged 16 to 18 years doing better than those aged 19 to 21 years. Although the 10-year relapse rate was lower for the COG patients (29% ± 6% versus 57% ± 8%, Gray's P <.001), this was offset by a higher postremission treatment-related mortality of 26% ± 6% versus 12% ± 6% (Gray's P <.001). Significant improvements in 10-year event-free survival and overall survival were observed for the entire cohort in later studies. CONCLUSIONS Patients treated on pediatric trials had better outcomes than those treated on adult trials, but age is a major confounding variable, making it difficult to compare outcomes by cooperative group.