Adolescent

From subset analyses of both pediatric and adult ALL clinical trials, the adolescent and young adult (AYA) population has a distinctive outcome. In pediatric studies, adolescents are considered a high-risk group, receiving more intensive treatment with the intent of improving outcome to achieve the successes noted in good-risk children of age 2-10.117118 In the adult cooperative groups, AYA have traditionally received similar treatment to older adults and have been viewed as a relatively good risk group.5 Several retrospective analyses have recently unveiled some striking differences in the outcome of AYA patients, depending upon "the door" they enter at the time of their diagnosis in determining enrollment on pediatric versus adult clinical trials.119-121 Retrospective comparisons of pediatric versus adult clinical trials for ALL in North America, France, and the Netherlands all reached similar conclusions: AYA patients fared significantly better when

Table 13.4 Outcome comparison of adolescent/young adults with ALL on pediatric versus adult clinical trials

Cooperative group

Study period/ number of patients

Age (years)

CR (%)

EFS (%)

North America119 CCG 1882 (pediatrics) CALGB 8811-9511 (adults)

1988-1998 196 patients 103 patients

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