Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials.
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.
Boissel
Nicolas
N
Services d'Hématologie Pédiatrique et Adulte, Laboratoire Central d'Hématologie, Hôpital Saint-Louis, France.
Auclerc
Marie-Françoise
MF
Lhéritier
Véronique
V
Perel
Yves
Y
Thomas
Xavier
X
Leblanc
Thierry
T
Rousselot
Philippe
P
Cayuela
Jean-Michel
JM
Gabert
Jean
J
Fegueux
Nathalie
N
Piguet
Christophe
C
Huguet-Rigal
Françoise
F
Berthou
Christian
C
Boiron
Jean-Michel
JM
Pautas
Cécile
C
Michel
Gérard
G
Fière
Denis
D
Leverger
Guy
G
Dombret
Hervé
H
Baruchel
André
A
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
D015260:Neprilysin