they were treated on pediatric protocols, despite that CR rates for AYA patients were generally comparable between adult and pediatric trials (Table 13.4).

Factors Affecting Treatment Outcome: Drug Dosage, Schedule, the Doctors, and the Patients

All of these studies have engendered vigorous debate about whether the disparity in outcome for AYAs on pediatric versus adult trials can be accounted for primarily by differences in the drug regimens and planned dose intensity, or whether the precision with which actual dose was delivered might have a significant role in patient outcome. In general, the pediatric regimens contained significantly higher cumulative doses of nonmyelosuppressive drugs, including gluco-corticoids, vincristine, and L-asparaginase. In addition, more frequent IT therapy was administered in the pediatric regimens, and maintenance therapy was generally administered for longer periods of time. As these are retrospective studies, dose delivery has been difficult to examine and may be influenced significantly by differences in adult versus pediatric physician attitude and experience with treatment of ALL. In addition, the attitudes, family support, and compliance of AYAs treated by adult versus pediatric oncologists may be different and relevant.

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