title: Survival improvements in adolescents and young adults after myeloablative allogeneic transplantation for acute lymphoblastic leukemia.
abstract: Adolescents and young adults (AYAs, ages 15 to 40 years) with cancer have not experienced survival improvements to the same extent as younger and older patients. We compared changes in survival after myeloablative allogeneic hematopoietic cell transplantation (HCT) for acute lymphoblastic leukemia (ALL) among children (n = 981), AYAs (n = 1218), and older adults (n = 469) who underwent transplantation over 3 time periods: 1990 to 1995, 1996 to 2001, and 2002 to 2007. Five-year survival varied inversely with age group. Survival improved over time in AYAs and paralleled that seen in children; however, overall survival did not change over time for older adults. Survival improvements were primarily related to lower rates of early treatment-related mortality in the most recent era. For all cohorts, relapse rates did not change over time. A subset of 222 AYAs between the ages of 15 and 25 at 46 pediatric or 49 adult centers were also analyzed to describe differences by center type. In this subgroup, there were differences in transplantation practices among pediatric and adult centers, although HCT outcomes did not differ by center type. Survival for AYAs undergoing myeloablative allogeneic HCT for ALL improved at a similar rate as survival for children.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: William A
authors.initials: WA
authors.lastname: Wood
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Division of Biostatistics, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Ruta
authors.initials: R
authors.lastname: Brazauskas
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia.
authors.forename: Mahmoud D
authors.initials: MD
authors.lastname: Aljurf
authors.affiliation: Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.affiliation: Department of Hematology, Children's Hospital of Orange County, Orange, California.
authors.forename: David K
authors.initials: DK
authors.lastname: Buchbinder
authors.affiliation: National Marrow Donor Program, Minneapolis, Minnesota.
authors.forename: Jason
authors.initials: J
authors.lastname: Dehn
authors.affiliation: Hematopoietic Stem Cell Transplant Program, South Texas Veterans Health Care System, San Antonio, Texas; University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: Cesar O
authors.initials: CO
authors.lastname: Freytes
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Hematology and Bone Marrow Transplant, Sarah Cannon, Nashville, Tennessee.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lemaistre
authors.affiliation: Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Paulette
authors.initials: P
authors.lastname: Mehta
authors.affiliation: Section of Haematology/Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Szwajcer
authors.affiliation: Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Steven
authors.initials: S
authors.lastname: Joffe
authors.affiliation: Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio. Electronic address: nmajhail@nmdp.org.
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adolescent and young adults; Allogeneic; Hematopoietic cell transplantation; Survival