title: Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials.
abstract: OBJECTIVE
  To compare pediatric and adult therapeutic practices in the treatment of acute lymphoblastic leukemia (ALL) in adolescents.
  
  
  METHODS
  From June 1993 to September 1994, 77 and 100 adolescents (15 to 20 years of age) were enrolled in the pediatric FRALLE-93 and adult LALA-94 protocols, respectively. Among the different prognostic factors, we retrospectively analyzed the effect of the trial on achieving complete remission (CR) and event-free survival (EFS).
  
  
  RESULTS
  Patients were younger in the FRALLE-93 than in the LALA-94 protocol (median age, 15.9 v 17.9 years, respectively), but other characteristics were similar, including median WBC count (18 x 10(9) cells/L v 16 x 10(9) cells/L), B/T-lineage (54 of 23 v 72 of 28 patients), CD10-negative ALL (13% v 15%), and poor-risk cytogenetics (t(9;22), t(4;11), or hypodiploidy less than 45 chromosomes: 6% v 5%). The CR rate depended on WBC count (P =.005) and trial (94% v 83% in FRALLE-93 and LALA-94, respectively; P =.04). Univariate analysis showed that unfavorable prognostic factors for EFS were as follows: the trial (estimated 5-year EFS, 67% v 41% for FRALLE-93 and LALA-94, respectively; P <.0001), an increasing WBC count (P <.0001), poor-risk cytogenetics (P =.005), and T-lineage (P =.01). The trial and WBC count remained significant parameters for EFS in multivariate analysis (P <.0001 and P =.0004). Lineage subgroup analysis showed an advantage for the FRALLE-93 trial for CR achievement (98% v 81%; P =.002) and EFS (P =.0002) in B-lineage ALL and for EFS (P =.05) in T-lineage ALL. Age was not a significant prognostic factor in this population of adolescents.
  
  
  CONCLUSIONS
  This study's findings indicate that adolescents should be included in intensive pediatric protocols and that new trials should be designed, inspired by pediatric protocols, for the treatment of young adults with ALL.
authors.affiliation: Services d'Hématologie Pédiatrique et Adulte, Laboratoire Central d'Hématologie, Hôpital Saint-Louis, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Boissel
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Auclerc
authors.forename: Véronique
authors.initials: V
authors.lastname: Lhéritier
authors.forename: Yves
authors.initials: Y
authors.lastname: Perel
authors.forename: Xavier
authors.initials: X
authors.lastname: Thomas
authors.forename: Thierry
authors.initials: T
authors.lastname: Leblanc
authors.forename: Philippe
authors.initials: P
authors.lastname: Rousselot
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Cayuela
authors.forename: Jean
authors.initials: J
authors.lastname: Gabert
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fegueux
authors.forename: Christophe
authors.initials: C
authors.lastname: Piguet
authors.forename: Françoise
authors.initials: F
authors.lastname: Huguet-Rigal
authors.forename: Christian
authors.initials: C
authors.lastname: Berthou
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Boiron
authors.forename: Cécile
authors.initials: C
authors.lastname: Pautas
authors.forename: Gérard
authors.initials: G
authors.lastname: Michel
authors.forename: Denis
authors.initials: D
authors.lastname: Fière
authors.forename: Guy
authors.initials: G
authors.lastname: Leverger
authors.forename: Hervé
authors.initials: H
authors.lastname: Dombret
authors.forename: André
authors.initials: A
authors.lastname: Baruchel
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D019070:Cell Lineage; D003131:Combined Modality Therapy; D020732:Cytogenetic Analysis; D018572:Disease-Free Survival; D005260:Female; D005602:France; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D015260:Neprilysin / Q000378:metabolism; D011003:Ploidies; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D011878:Radiotherapy; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D015260:Neprilysin